PMC8585856_01
MR-imaging during disease course. Sagittal FLAIR- and axial T1 gadolinium sequences. (A) Moderate lesion load under fingolimod treatment. (B) Frontoparietal tumefactive lesions with disseminated Gadolinium-enhancement 6 weeks after discontinuation of fingolimod. (C) Remittent Gadolinium-enhancement after four cycles of plasmapheresis. (D) Further remission at re-admission 2 weeks after the last cycle of plasmapheresis; asterisk indicates active lesion. (E) Lesions decreasing in size 6 months after ocrelizumab initiation (only axial FLAIR available).
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F1
MRI revealed numerous tumefactive lesions with Gad enhancement and edema atypical of her prior disease course (Figure 1A prior MRI; Figure 1B MRI at admission). Follow-up MRI showed a decrease of the lesion size and number as well as the Gad enhancement (Figure 1C). While MRI showed an overall decrease of Gad-enhancing lesions one subcortical lesion had remained active (Figure 1D, asterisk). MRI showed a further remission with no remaining Gad enhancement (Figure 1E).
Clinical course and total lymphocyte count. Total lymphocyte count (TLC)/mul is depicted over the disease course. Relapses are shown as red squares. Duration of disease modifying therapies is shown with the black symbols, respectively. Ocrelizumab therapy was initiated and is still ongoing.
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F2
Figure 2 shows an overview of the clinical course including relapses and DMT switches as well as total lymphocyte counts.