Highly Aggressive Multiple Sclerosis Relapse During Pregnancy Following SARS-CoV-2 Infection: A Case Report and Literature Review

Abstract

Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.; We report a challenging case of a 32-year-old previously healthy pregnant woman at 17+2 weeks gestation with a new diagnosis of exceptional highly active relapsing-remitting multiple sclerosis (RRMS) triggered by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Remarkable clinical characteristics were the rapid clinical deterioration, the severity and the nature of the symptoms, including spastic tetraplegia, dyspnea, dysphagia, anarthria, and a severe pain syndrome, which resulted in the need for intensive care and mechanical ventilation within 24 hours. Relapse treatment, as well as symptomatic treatment, was challenging and complicated by pregnancy. Early diagnosis, consistent and persistent interdisciplinary management including six weeks stay in the intensive care unit and 3.5 months in neurorehabilitation, led to a full recovery of the patient and a healthy born child. In addition to the remarkable clinical characteristics, we report the challenging therapeutic measures throughout the hospitalization. This case report could, therefore, assist others who may be confronted with a similar situation. (Copyright © 2025, Meyer et al.)