Commentary: Acute Hemorrhagic Leukoencephalitis (Weston-Hurst Syndrome) in a Patient with Relapse-Remitting Multiple Sclerosis.

Abstract

Recently, Yildiz et al. reported the occurrence of acute hemorrhagic leukoencephalitis (AHLE) in a patient with pluriannual relapse-remitting multiple sclerosis (MS) after 1 month of high-dose interferon-β-1a treatment. The authors raised the question whether this case may be a hyperacute form of acute disseminated encephalomyelitis (ADEM) or a rare hemorrhagic evolution of tumefactive demyelination (TD), both unusual in the course of MS (1). They concluded that AHLE occurrence was unrelated to the underlying MS since hemorrhage has not been found in neuropathological patterns of both MS and TD. Although two published case reports of TD with hemorrhage in the course of fingolimod and natalizumab therapies (brain biopsy was not performed) have been mentioned in the paper, the potential predisposing effect of interferon-β therapy on the AHLE development has not been hypothesized.