Primary progressive multiple sclerosis to be treated with ocrelizumab: A mistaken case of cobalamin deficiency

Sydney Feldman, Salman Aljarallah, Shiv Saidha

Research output: Contribution to journalArticle


Cobalamin (vitamin B 12) deficiency often manifests with neurologic symptoms and may rarely mimic multiple sclerosis (MS) among other neurological disorders. However, MRI changes associated with cobalamin deficiency are typically spinal predominant and distinct from MS-related changes. We report a case of a patient with cobalamin deficiency who was recommended by her primary neurologist to commence treatment with ocrelizumab, a potent anti-CD20 B-cell depleting monoclonal antibody, after being diagnosed with primary progressive MS. However, cervical spine MRI demonstrated changes classical of cobalamin deficiency including â € inverted V sign' signal hyperintensity and following parenteral cobalamin supplementation her neurological symptoms quickly and dramatically improved.

Original languageEnglish (US)
Article numbere229080
JournalBMJ case reports
Issue number5
Publication statusPublished - May 14 2019



  • multiple sclerosis
  • vitamins and supplements

ASJC Scopus subject areas

  • Medicine(all)

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