Relapses after treatment with rituximab in a patient with multiple sclerosis and anti-myelin-associated glycoprotein polyneuropathy

Objective: To describe the unique case of a patient with multiple sclerosis (MS) and anti-myelin-associated glycoprotein (MAG) polyneuropathy who developed MS relapses after treatment with rituximab. Design: Case report. Setting: Department of Neurosciences, Ophthalmology, and Genetics, University of Genova, Genova, Italy. Patient: A 59-year-old man with an 18-year history of MSpresented with an unusually rapid progression of paraparesis with hypopallesthesia and areflexia in 4 limbs. Neurophysiological and serological studies led to the diagnosis of anti-MAG polyneuropathy. Cerebrospinal fluid analysis disclosed the loss of oligoclonal IgG bands that were previously detected at MS onset. Intervention: Rituximab was administered at a dosage of 375 mg/m2/wk for 4 weeks. Result: The patient developed 2 corticosteroid-responsive MS relapses with improvement of the polyneuropathy. Conclusion: Rituximab can be effective in anti-MAG polyneuropathy but can possibly lead to unexpected consequences in individuals with MS.