A case series and literature review of multiple sclerosis and COVID-19: Clinical characteristics, outcomes and a brief review of immunotherapies

Abstract

Background: In view of the emerging coronavirus pandemic, the demand for knowledge about the impact of SARS-CoV-2 on people with Multiple Sclerosis (MS) continues to grow. Patients receiving disease modifying therapy (DMT) for MS have a higher background risk of infection-related health care utilization when compared to the general population. Therefore, there is a need of evidence-based recommendations to reduce the risk of infection and also managing MS patients with SARS-CoV-2.

Case description: We present three patients with history of Multiple Sclerosis (MS) on DMTs presenting with worsening MS symptoms likely pseudo exacerbation who were diagnosed with COVID-19.

Discussion: An extensive review of 7 articles was performed, in addition to a brief review on DMTs use in MS patients with COVID-19. In our cases, all patients were on DMT and severe course of disease was noted in 2 cases. No fatality was observed.

Conclusions: This review provides a base on the clinical characteristics, outcomes and the roles of DMTs in MS patients suffering from n-cov-2. Physicians need to be vigilant about considering COVID-19 infection related relapse in the MS patients, especially in this COVID-19 pandemic era and look for pseudo-exacerbation. As most cases are found to have mild course and full recovery on DMTs, further research is needed to formulate evidence-based guidelines. This review will particularly be helpful for the researchers and registries to collect future data on MS and COVID-19.

Keywords: ALT, Alanine Transaminase; AST, Aspartate Transaminase; ATS/IDSA, American Thoracic Society and Infectious Disease Society of America; Antigen presenting cells, (APCs); BUN, Blood Urea Nitrogen; COVID-19; COVID-19, Coronavirus Disease 2019; CRP, C-Reactive Protein; CSF, Cerebrospinal fluid; CT, Computed Tomography; DMT, Disease Modifying Therapy; EDSS, Expanded Disability Status Score; IV, Intravenous; Immunotherapies; JCV, John Cunnigham virus; L, Liters; MS, Multiple Sclerosis; Multiple sclerosis; NK cells, Natural Killer Cells; Novel coronavirus; Ocrelizumab; PPMS, Primary Progressive Multiple Sclerosis; Progressive multifocal leukoencephalopathy, (PML).; RRMS, Relapsing Remitting Multiple Sclerosis; RT PCR, Reverse Transcription Polymerase Chain Reaction; SARS-CoV-2; SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2; Terminally differentiated late effector memory T cells, (TEMRA); n-Cov2, Novel coronavirus 2; ul, Microliters.

© 2020 The Authors.

Figures

Fig. 1

Axial FLAIR (1a), Sagittal FLAIR (1b), post contrast T1 (1c) magnetic resonance imaging showing ovoid hyperintense lesions in periventricular distribution in Fig. 1a and b. No enhancing lesion seen on post contrast image Fig. 1c. FLAIR - Fluid attenuated inversion recovery.

Fig. 2

Axial FLAIR (2a), Sagittal FLAIR (2b), post contrast T1 (2c) magnetic resonance imaging showing ovoid hyperintense lesions in periventricular distribution in Fig. 2a and b. No enhancing lesion seen on post contrast image Fig. 2c. FLAIR - Fluid attenuated inversion recovery.

Fig. 3

Axial FLAIR (3a), Sagittal FLAIR (3b), post contrast T1 (3c) magnetic resonance imaging showing ovoid hyperintense lesions in periventricular distribution in Fig. 3a and b. No enhancing lesion seen on post contrast image Fig. 3c. FLAIR - Fluid attenuated inversion recovery.