Severe paradoxical disease activation following alemtuzumab treatment for multiple sclerosis

Abstract
A 39-year-old right-handed agricultural service engineer developed rapidly evolving severe relapsing-remitting multiple sclerosis (MS). MRI showed multiple T2 hyperintensities throughout his neuroaxis (figure, A). Several lesions showed restricted diffusion, and 2 enhanced. He received steroids for each relapse, making a full recovery (Expanded Disability Status Score [EDSS] 0).