A 45-year-old woman with relapsing-remitting multiple sclerosis presents with bilateral ascending weakness, areflexia, and albuminocytologic dissociation on CSF analysis (protein 120 mg/dL, cells 3/μL) 2 weeks after a respiratory infection. Nerve conduction studies show prolonged distal latencies and slowed conduction velocities. What is the most appropriate treatment?
- A Intravenous immunoglobulin (IVIG) or plasmapheresis ✓
- B High-dose IV methylprednisolone
- C Interferon beta-1a subcutaneous injection
- D Natalizumab infusion
Correct answer: A. Intravenous immunoglobulin (IVIG) or plasmapheresis
Explanation
This presentation is Guillain-Barré syndrome (GBS), characterized by post-infectious ascending flaccid paralysis, areflexia, and albuminocytologic dissociation in CSF. Although the patient has MS, this acute event represents a superimposed GBS (a distinct post-infectious demyelinating polyneuropathy). Treatment for GBS is IVIG (0.4 g/kg/day for 5 days) or plasmapheresis; steroids are ineffective and may be detrimental in GBS. MS disease-modifying agents are not appropriate here.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.