[P02.154] Severe Multiple Sclerosis Exacerbation during the 3^rd Trimester of Pregnancy Presenting with Tumefactive MRI Lesions

Zeenat Jaisani, David Hojnacki, Bianca Weinstock Guttman, Buffalo, NY

OBJECTIVE: To report two cases of multiple sclerosis (MS) with severe exacerbations during the third trimester of pregnancy with tumefactive brain magnetic resonance imaging (MRI) lesions. BACKGROUND: MS is an auto-immune demyelinating disease of central nervous system. Disease activity in MS patients is usually suppressed during pregnancy whereas the attack frequency increases after delivery. It is yet unclear, which immuno-endocrinological processes mediate these changes. DESIGN/METHODS: We report 2 cases presenting with severe exacerbations during their 3^rd trimester of pregnancy. An abnormal Th2 immunological response mounted during late pregnancy can explain the malignant clinical and MRI outcome. RESULTS: 23 year old caucasian woman, without significant past medical history, presented with right side weakness and numbness during her third trimester of pregnancy (29 weeks). MRI of the brain revealed both supra- and infra-tentorial lesions suggestive of MS, with one large left periventricular lesion with surrounding edema consistent with a tumefactive lesion. The subsequent clinical presentations, repeat MRI's and lumbar puncture confirmed the diagnosis of MS. Patient was treated initial with intravenous (IV) methylprednisolone with good response. 39 year old Caucasian woman with a history of MS presented with progressive left side hemiplegia that worsened over the course of 3 days during her third trimester (33 weeks) of pregnancy. MRI brain revealed several new T2 hyperintense lesions including one large tumefactive lesion in the right posterior frontal region. Patient was treated with IV methylprednisolone prior to delivery with no improvement. She required further IVIG (immunoglobulin), plasmapharesis and cyclophosphamide for disease stabilization. CONCLUSIONS/RELEVANCE: We report two cases of MS exacerbation with malignant disease associated with MRI tumefactive lesions during last trimester of pregnancy. This association may suggest an abnormal humoral related pathology that can be seen during an immune shift toward a Th2 milieu.
Category - MS and Related Diseases - Clinical Science

Tuesday, April 13, 2010 3:00 PM

Poster Session II: Multiple Sclerosis and Related Diseases: Clinical Research/Biomarkers (3:00 PM-7:30 PM)