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

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.