Title : The malignant Marburg malady of Manila: A case of acute fulminant multiple sclerosis (Marburg Variant) in a 38-year-old Filipino female
Abstract:
Background: Multiple Sclerosis (MS) is a demyelinating disease which is particularly rare in tropical regions like the Philippines, where epidemiologic incidence is 10 to 20 times lower than in temperate zones. Fulminant and tumefactive MS variants, such as the Marburg Variant, present with extreme diagnostic and therapeutic difficulties
due to its rapid, monophasic, and progressive course and its propensity to mimic intracranial neoplasms.
Case Description: A 38-year-old, previously fully-abled Filipino female presented with a three-month history of progressive bitemporal and retroorbital headaches, subsequent bilateral blindness with papilledema, and a new-onset generalized tonic-clonic seizure. Magnetic resonance spectroscopy revealed large inflammatory lesions with severe vasogenic edema in the left frontal and parietal lobes, mimicking a primary brain tumor or encephalitis. Extensive cerebrospinal fluid analysis, including oligoclonal bands, anti-aquaporin-4, and anti-MOG antibodies, returned negative, pointing toward an atypical fulminant MS variant. Despite temporary stabilization as an outpatient with systemic steroids and anticonvulsants, the patient succumbed to clinical deterioration. On readmission, she presented with total blindness, decreased sensorium, unequal pupillary light reflex, slurred speech, and vomiting secondary to increased intracranial pressure. She was initially stabilized after medical decompression and Rituximab infusion, but succumbed to acute deterioration which eventually caused her demise.
Conclusion: The current case highlights the clinical presentation of an aggressive, tumefactive MS variant in a low-risk demographic. The negative yield for the expected biomarkers and the rapid progression to neurological compromise signify the need for early clinical recognition, aggressive comprehensive intervention, and the development of standardized management strategies for fulminant demyelinating diseases such as the Marburg variant of Multiple Sclerosis.
