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Título

MARBURG VARIANT OF MULTIPLE SCLEROSIS AFTER COVID-19 SUCCESSFULLY TREATED WITH BETAINTERFERON 1A – A CASE REPORT

RESUMO

Case report
A 20-year-old female patient previously healthy had a mild Covid-19 one month before neurological symptoms. Four days before admission, she started with paresthesia in the inferior left limb. The neurological examination showed complete left hemiparesis and painful hypoesthesia on the left side. She was submitted to a brain magnetic resonance imaging (MRI) that evidenced hyperintense subcortical lesions on T2/FLAIR and hypointense on T1. She received a five days course of methylprednisolone 1g with partial improvement of the symptoms and she was discharged to ambulatorial following. After one month, the patient went back to emergency with focal seizures in the face and worsening of left hemiparesis. The new MRI showed an increase of hyperintense T2/FLAIR lesions on the right frontotemporal. Due to the fast and aggressive presentation with neurological deterioration and failure of initial therapy, the possibility of Marburg’s variant of MS was suggested. It was decided to start beta interferon 1a with 44 mcg three times a week. After one month of the new therapy, the patient presented an improvement of symptoms, reduction of lesions in MRI.


Discussion
The Marburg variant is a particular form of MS. It is known this results in myelin sheath instability that contributes to the formation of demyelinating plates. Generally, the injuries show a widespread and inflammatory aspect. The neuroimaging generally reveal multiple extensive lesions, involving the white matter. Our case report showed an evolution of neurological injuries in a healthy patient, except history of Covid-19, possibly a trigger of this demyelinating disease. The first-line therapy is the use of glucocorticoids in high doses, and the second-line is intravenous immunoglobulin and plasmapheresis. After the progression of deficits, we decided to treat with betainterferon 1a, which stops that progression, improved neurological symptoms and promoted regression of brain lesions. Although this medication is not commonly indicated for this form of disease, it shows the immune factor in the Marburg variant and its potential to respond to immunomodulatory drugs.


Conclusion
The Marburg variant of MS requires a high level of clinical suspicion and knowledge about different MS presentations. We present a peculiar case because a correlation with Covid-19 made this a possible trigger and the good response with beta interferon 1a showed a possible drug to consider in management of this disease.