Author Of 1 Presentation
P1136 - Severe neuroinflammatory relapse after ectopic pregnancy termination: a case report on MS patient with myelin oligodendrocyte glycoproteinantibodies. (ID 757)
Abstract
Background
Pregnancy has disease-modifying effects in MS with declined disease activity during the third trimester and increased relapse rate postpartum. A recent study indicates that abortion is associated with a clinical and radiological rebound effect 12 months post-event. MS with myelin oligodendrocyte glycoprotein (MOG) autoantibodies is a rare disease variant and the effects of pregnancy or abortion have not been studied.
Objectives
With this case rapport we want to share our experience on severe inflammatory reactivation after ectopic pregnancy and surgical abortion in MS patient who carries MOG antibodies.
Methods
This is a clinical case report on a female MS patient from Middle East, born in 1976, who moved to Sweden in 2007. She suffered from optic neuritis in 2008. In 2010, our patient got a diagnosis of MS, McDonald criteria 2005 were fulfilled. During 2011-2014 she was treated with interferon beta-1a. Due to relapses and new MRI lesionsthe treatment was changed to dimehtyl fumarate (DMF) in 2015 and the dose was halved due to side effects. In August 2019, DMF was terminated due to secondary progressive disease course. Later that month, the patient underwent a surgical abortion due to ectopic pregnancy.
Results
Post-abortion, the patient developed >50 T2 lesions and 8 Gd+ lesions on brain MRI. Cerebrospinal fluid analysis showed increased levels of neurofilament light (NFL) at 13700 ng/L (ref <890 in age group 40-60).
Conclusions
This case report illustrates a severe neuroinflammatory MS reactivation after a preterm pregnancy termination. The discontinuation of DMF just prior abortion may have contributed to the inflammatory rebound after abortion. The role of MOG antibodies in inflammatory reactivation post-abortion needs to be clarified.