{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T12:21:31Z","timestamp":1782476491203,"version":"3.54.5"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Marburg variant of multiple sclerosis (MS) is a rare, fulminant demyelinating disorder characterized by rapid neurological decline and notable lack of established standardized treatment guidelines. We describe a 46-year-old woman presenting with progressive cognitive and behavioral changes and multifocal CNS lesions initially refractory to corticosteroids, plasmapheresis (PLEX), and intravenous immunoglobulin (IVIg). Brain biopsy confirmed aggressive MS-spectrum demyelination. Escalation to high-dose cyclophosphamide resulted in radiologic stabilization but was limited by severe, refractory cytopenia. Given persistent disease activity and intolerance to infusion-based therapy, transition from ocrelizumab to subcutaneous ofatumumab was planned as a pragmatic maintenance strategy; however, treatment initiation was delayed. The patient subsequently experienced rapid clinical deterioration marked by recurrent aspiration events and functional decline, ultimately leading to death following transition to comfort-focused care. This case highlights the therapeutic challenges of Marburg MS, including treatment-limiting toxicity, logistical barriers to anti-CD20 therapy, and the critical importance of timely, individualized immunosuppressive strategies.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1816028","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T05:43:52Z","timestamp":1778737432000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Marburg variant of multiple sclerosis and review of its complicated treatment"],"prefix":"10.3389","volume":"17","author":[{"given":"Anjan","family":"Bhattarai","sequence":"first","affiliation":[{"name":"Department of Neurology, St. Vincent Mercy Medical Center","place":["Toledo, OH, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Awwad","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. 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