Marburg MS case shows treatment challenges and fatal outcome

A 46-year-old woman with the Marburg variant of multiple sclerosis presented with severe, rapidly progressive disease. Initial treatment with corticosteroids, plasmapheresis, and intravenous immunoglobulin failed to control her lesions, leading to a switch to high-dose cyclophosphamide. This provided radiologic stabilization but was severely limited by the development of refractory cytopenia.

The patient was then transitioned from ocrelizumab to subcutaneous ofatumumab, but her clinical course rapidly deteriorated. She experienced recurrent aspiration events and significant functional decline, ultimately resulting in death. This case underscores the extreme aggressiveness of Marburg MS and the narrow therapeutic window for effective intervention.

The report highlights critical therapeutic challenges, including treatment-limiting toxicities like cytopenia and logistical barriers to administering anti-CD20 therapies. It emphasizes the need for timely, individualized immunosuppressive strategies in such aggressive presentations. The case serves as a stark reminder of the potential for fatal outcomes despite aggressive treatment escalation.

Limitations include the single-case design, which limits generalizability. However, the detailed clinical course provides valuable insight into managing this rare and severe MS variant. The findings stress the importance of early, aggressive intervention while carefully monitoring for adverse events.