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Mult Scler. 2012 Jul;18(7):1045-9. doi: 10.1177/1352458511429012. Epub 2011 Nov 15.

Favourable response to plasma exchange in tumefactive CNS demyelination with delayed B-cell response.

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Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany.


We report a case of multiple sclerosis-associated fulminant tumefactive demyelinating lesion (TDL) with the special feature of delayed humoral immune response. Plasma exchange (PE) yielded significant benefit in two consecutive steroid-unresponsive relapses, while signs of an intrathecal B-cell response were only present 2 years later at the second relapse. Remission was achieved and sustained thereafter with natalizumab. Our case indicates that PE might be a therapeutic option even when the B-cell response is not fully developed. This delay in the development of a humoral immune response may reflect the step-wise B-cell colonization of the CNS and represent an attractive therapeutic window of opportunity.

[Indexed for MEDLINE]

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