Amyloidoma mimicking multiple sclerosis

A 56-year-old woman developed optic neuritis in 2001 and progressive right-sided weakness dating from 2015. MR scan of the brain showed a solitary contrast-enhancing lesion in the left periventricular region and her cerebrospinal fluid (CSF) contained unmatched oligoclonal IgG bands. In 2017, she was diagnosed with multiple sclerosis (MS) and started disease-modifying treatment with glatiramer acetate. However, her symptoms progressed and she was referred to our centre for consideration of treatment escalation. On examination, she had a right haemiplegia with pronounced hypertonia, decreased left visual acuity and an afferent pupillary defect.

Repeat MR scan of the brain showed that the lesion had grown, with persisting patchy but avid contrast-enhancement (figure 1A,B). Subsequent neuropathological examination (figure 1C) showed widespread deposition of intraparenchymal and intravascular amyloid. We subsequently excluded systemic amyloidosis based on: the absence of visceral amyloid deposits on serum amyloid P scintigraphy; a normal ECG with sinus…

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