PMC8134535_01
Timeline of (A) EDSS scores, (B) relapses, and (C) treatment. *Rituximab dose: 2 x 1 g, 2 weeks apart, then every 6 months.  Eculizumab dose: 900 mg weekly (first four doses) then 1,200 mg every 2 weeks.  5 exchanges on alternate days.  3-5 exchanges on alternate days every 4 weeks. BID, twice daily; EDSS, Expanded Disability Status Scale; IV, intravenous; PLEX, plasma exchange.
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F1
Figure 1 and the clinical course is described in Figure 2. Following her initial presentation the patient was admitted to hospital and treated with intravenous methylprednisolone at a dose of 1 g/day for 5 days, after which she was discharged without medication to acute rehabilitation. The patient continued to experience relapses between 2014 and 2019, with 4-5 relapses per year (Figure 1), characterized by lower limb weakness. EDSS (score of 2-3; lower scores indicate less disability) (Figure 1) and she experienced no relapses or adverse events. Eculizumab was discontinued in December 2019 when the patient's insurance provider denied continued coverage despite peer-to-peer review.
Timeline of clinical presentation and investigations. -ve, negative; AQP-4, aquaporin-4; IgG, immunoglobulin G; MOG, myelin oligodendrocyte glycoprotein; MRI, magnetic resonance imaging.
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F2
Figure 1 and the clinical course is described in Figure 2. Following her initial presentation the patient was admitted to hospital and treated with intravenous methylprednisolone at a dose of 1 g/day for 5 days, after which she was discharged without medication to acute rehabilitation.