A 26-y.o. woman with RRMS and eruption of plaques.

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Presentation transcript:

A 26-y.o. woman with RRMS and eruption of plaques. Teaching NeuroImages Neurology Resident and Fellow Section © 2017 American Academy of Neurology

Case presentation A 26-year old female patient with a history of mild localized psoriasis in elbows and knees is diagnosed with relapsing-remitting multiple sclerosis and started on s.c. interferon-β 1a tiw. Expanded Disability Status Scale (EDSS) score at the time of diagnosis was 1 Brain MRI fulfilled revised 2010 McDonald criteria for dissemination of lesions in time and space. 4 months later an extensive eruption of psoriasiform lesions developed (plaques and guttate lesions covering extremities, band of confluent plaques along s.c. injection sites in the abdomen). Interferon was discontinued and the patient was started on oral dimethyl fumarate (DMF). 14 months following initiation of oral DMF the lesions showed almost complete remission and the patient remained relapse-free with an EDSS-score of 1. Tsivgoulis et al © 2017 American Academy of Neurology

Tsivgoulis et al D B C E A F © 2017 American Academy of Neurology Figure legend. A-C: Plaques and guttate lesions in the lower (A, B, arrows) and upper (C, arrows) extremities. Confluent plaques demonstrate Koebner phenomenon along the interferon injection sites (C, arrowheads). D-F: Remission of psoriatic eruptions 14 months after treatment with oral dimethyl fumarate. Residual discoloration in former Koebner-positive sites (E, arrowheads). © 2017 American Academy of Neurology Tsivgoulis et al

INTERFERON-INDUCED PSORIASIS FLARE IN A MULTIPLE SCLEROSIS CASE REMITS WITH DIMETHYL FUMARATE. There is evidence indicating a possible correlation of multiple sclerosis and psoriasis1. Interferon as a disease-modifying treatment for patients with multiple sclerosis may induce an exacerbation of psoriasis Also, injections may induce a Koebner-positive psoriatic response in situ. Oral dimethyl fumarate, another disease-modifying therapy for multiple sclerosis, may improve concomitant psoriasis2 and could be a useful therapeutic option for these patients. References Fellner A, Dano M, Regev K, Mosek A, Karni A. Multiple sclerosis is associated with psoriasis. A case-control study. J Neurol Sci. 2014 Mar 15;338(1-2):226-8. Ghoreschi K, Brück J, Kellerer C et al. Fumarates improve psoriasis and multiple sclerosis by inducing type II dendritic cells. J Exp Med. 2011 Oct 24;208(11):2291-303. Tsivgoulis et al © 2017 American Academy of Neurology