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Neurological Rehabilitation

(Kiosk 3) A Rare Case: Atypical Multiple Sclerosis vs. HHV 6 Myelitis in a Young Man

Thursday, November 16, 2023
12:45 PM – 2:15 PM CT

    Primary Author(s)

  • Daniella Lipnick, MD

    Resident
    Montefiore Medical Center/Albert Einstein College of Medicine PM&R Program
    NEW YORK, New York

    • Co-Author(s)

  • JS

    Joseph M. Seldin, LicAc, MD

    Attending Physician
    NYC Health + Hospitals/North Central Bronx
    New York, New York

  • Mihir Jani, MD

    Resident Physician
    Montefiore Medical Center/Albert Einstein College of Medicine PM&R Program
    New York, New York

  • RM

    Ria Malhotra, MD

    Resident Physician
    Montefiore Medical Center/Albert Einstein College of Medicine PM&R Program
    New York, New York

Case Diagnosis: This is a rare case of Atypical MS vs. HHV6 in a young man presenting with progressive weakness and difficulty ambulating.

Case Description or Program Description: A 46-year-old male with a past medical history of malaria and hypertension presented to our hospital with 3 months of progressive weakness, difficulty ambulating and pain with neck flexion. On exam, he had greater proximal than distal weakness in all extremities, loss of vibratory sensation in the lower extremities, and bilateral ankle clonus.

Setting: Tertiary Medical Center

Assessment/Results: The patient underwent a course of IVIG and steroids with modest improvement. He was then discharged to the rehab floor where an LP was done showing only one oligoclonal band in his CSF and he was positive for HHV6 in both his serum and CSF. MRI T-spine revealed a non-specific focus of T2 hyperintensity at C2-C3 and MRI brain did not show periventricular demyelination. Ultimately HHV6 myelitis was ruled out because it tends to only occur in immunocompromised individuals. These findings led to the diagnosis of atypical MS.

Discussion (relevance): Atypical Multiple Sclerosis (MS) is characterized by clinical signs and symptoms of MS, that lack the typical lab work or imaging findings that are required to meet the McDonald criteria. It is important to rule out other potential causes before making a diagnosis of atypical MS. Atypical MS might not respond to the conventional treatments of IVIG. Experimental treatments such as rituximab are now being considered, such as in our patient.

Conclusions: It is important to identify patients who present with atypical forms of MS after excluding other etiologies. Early diagnosis of atypical MS can lead to early treatment and rehabilitation. However, more research is needed to determine the best pharmacologic treatment and rehabilitation program for atypical MS compared to patients with typical features.