SARS-CoV2 infection as a potential trigger for severe relapse in a patient with multiple sclerosis who stopped disease modifying treatment due to COVID-19 pandemic

Auer, Michael; Berek, Klaus; Fava, Elena; Zinganell, Anne; Deisenhammer, Florian; Hegen, Harald; Di Pauli, Franziska

Background During COVID-19 pandemic safety of disease modifying treatments (DMT) in patients with multiple sclerosis (MS) is still under debate. While there is no clear evidence for a higher risk of severe SARS-CoV-2 infection under DMT the risk of rebound of disease activity in case of stopping DMT is obvious. Case report We present the case of a 27-year-old patient with highly active relapsing remitting MS who interrupted DMT with alemtuzumab due to safety concerns and fear of COVID-19. Eventually, she developed COVID-19 disease and, concomitantly, a severe and disabling relapse requiring plasmapheresis. Conclusion This case raises the question whether SARS-CoV-2 might trigger disease reactivation as other viral infections were described to potentially trigger MS relapses. Furthermore, it reinforces the discussion on MS treatment during COVID-19 pandemic and shows the challenge of weighing up the elevated risk of COVID-19 and of severe MS relapse when interrupting an effective DMT.