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Título

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

RESUMO

A 20-year-old female patient previously healthy had a history of mild covid-19 one month before neurological symptoms. Four days before admission she started with paresthesia in the inferior left limb, evolving with paresis and visual blurring. Neurological examination showed complete left hemiparesis with pyramidal signs and clonus, loss of proprioception and vibration in lower limbs, tactile and painful hypoesthesia on the left side, slightly scanning speech and hemiparetic gait. Differential diagnosis (DD) was with infectious, inflammatory and rheumatologic tests, all negative. Magnetic resonance imaging (MRI) showed diffuse hyperintense subcortical lesions on T2/FLAIR and hypointense on T1, involving periventricular white matter and brainstem. Methylprednisolone was initiated, with partial improvement of the symptoms. After one month, the patient had focal seizures in the face and worsening of left hemiparesis, with MRI revealing increase of hyperintense T2/FLAIR lesions on the right frontotemporal and parietal lobes, pons and cerebellar regions. DD was tumecfative demyelination or tumor. The family didn’t agree about the brain biopsy. The possibility of Marburg’s variant of MS was suggested. Interferon beta therapy was initiated three times a week. After one month, the patient presented improvement of symptoms and reduction of lesions in MRI, with continuous improvement in the following months. Marburg variant is a form of MS that has a single-phase course and can lead to death in weeks to months after the initial presentation, an uncommon outcome in the general MS patients. The distribution of the lesions can be exactly as MS, though, in this variant, they spread to diverse brain areas, even including the brainstem. Differential diagnoses, such as tumor, infectious, granulomatous, and vasculitic lesions must be excluded. Neuroimaging alterations are not specific, involving the white matter of the hemispheres and brainstem. Our report showed evolution of neurological injuries in a patient with no previous conditions, except history of covid-19, possibly a trigger of the disease. The patient was treated with doses of steroids with partial response. After the progression of deficits, treatment with betainterferon 1-a was proposed, regressing symptoms and brain lesions. We present Marburg variant of MS its correlation with covid-19 as a possible trigger and the good response with beta-interferon.

Palavras Chave

MARBURG VARIANT OF MULTIPLE SCLEROSIS, COVID-19