Tumefactive Relapsing-Remitting Multiple Sclerosis in A 42-Year-Old Male: A Case Report

Rocksy Fransisca V. Situmeang; Nadia Gabriella

doi:10.56951/yc31g757

Tumefactive Relapsing-Remitting Multiple Sclerosis in A 42-Year-Old Male: A Case Report

Penulis

Rocksy Fransisca V. Situmeang Department of Neurology, Siloam Hospitals Lippo Village, Tangerang, Banten, Indonesia and Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia
Nadia Gabriella Department of Neurology, Siloam Hospitals Lippo Village, Tangerang, Banten, Indonesia and Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia

DOI:

https://doi.org/10.56951/yc31g757

Kata Kunci:

multiple sclerosis, tumefactive multiple sclerosis, penyakit demielinasi

Abstrak

Pendahuluan: Tumefactive multiple sclerosis TMS merupakan varian sklerosis multipel (multiple sclerosis/MS) yang langka, ditandai oleh lesi demielinisasi akut menyerupai tumor pada sistem saraf pusat (SSP). Gambaran pada TMS sering menyerupai space-occupying lesion (SOL), seperti neoplasma dan abses SSP, sehingga menimbulkan tantangan diagnostik. Kami melaporkan kasus TMS pada seorang laki-laki berusia 42 tahun. Presentasi kasus: Seorang laki-laki berusia 42 tahun datang dengan riwayat defisit neurologis hilang timbul selama 8 bulan, meliputi tetraparesis, gangguan sensoris, penurunan kesadaran, paresis nervus fasialis (CN VII) dan nervus hipoglosus (CN XII), serta afasia nonfluen. Analisis cairan serebrospinal menunjukkan peningkatan level protein dan penanda inflamasi, termasuk interleukin IL-6, IL-10, dan soluble IL-2 receptor (sIL-2R), dengan hasil antibodi anti-aquaporin-4 (AQP4) dan antibodi anti-myelin oligodendrocyte glycoprotein (MOG) negatif. Pemeriksaan magnetic resonance imaging (MRI) otak awal memperlihatkan lesi substansia alba multipel dengan penyangatan kontras dan gambaran incomplete ring enhancement. Setelah terapi methylprednisolone intravena dosis tinggi, terjadi perbaikan klinis, namun pasien mengalami kekambuhan dalam kurun waktu yang relatif singkat. MRI saat follow-up menunjukkan regresi pada sebagian besar lesi, disertai munculnya lesi baru pada medula spinalis servikal (level C2–C4). Pasien didiagnosis dengan TMS tipe relapse-remisi (relapsing remitting multiple sclerosis/RRMS) dan kembali mendapatkan terapi methylprednisolone intravena dosis tinggi, diikuti dengan inisiasi terapi menggunakan mycophenolate mofetil. Kesimpulan: Kasus ini menegaskan bahwa TMS penting untuk dipertimbangkan sebagai diagnosis banding pada pasien yang menunjukkan lesi otak besar dengan penyangatan kontras, meskipun gambaran klinis dan radiologi tidak khas untuk MS.

Unduhan

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