To describe a case of 47 years old male who developed Baló concentric sclerosis after 2 weeks of COVID-19 infection.

Since the outbreak of COVID-19 infection, several cases have been reported with para and post-infectious demyelinating conditions. In this study we describe a case of Baló concentric sclerosis, a rare and severe form of MS, that was triggered by COVID-19 infection.

Case report.

Our case is a 47 year old male with no previous history of demyelinating event, who presented with vertigo and left sided weakness. He had COVID-19 infection 2 weeks prior to his symptoms. MRI brain revealed multiple enhancing lesions in both cerebral hemispheres. CSF studies notable for mildly elevated protein with elevated myelin basic protein, but no oligoclonal bands. ANA, ANCA, AQP4, MOG, paraneoplastic panel normal. No evidence of malignancy noted on CT chest/abdomen/pelvis and scrotal ultrasound. MRI cervical and thoracic spine without any lesion. He was empirically started on high dose steroids, but his left sided weakness worsened and repeat MRI brain showed enlargement of the lesions. Steroids were discontinued and neurosurgery was consulted for biopsy. Biopsy results consistent with demyelinating disease. Meanwhile he started developing right sided weakness as well. Plasmapheresis was started with significant clinical improvement. He ultimately received induction therapy with rituximab. MRI brain with significant improvement and resolution of enhancement. When seen in the clinic at 6 weeks after rituximab induction he was noted to have significant improvement with near complete resolution of right sided weakness.

Our case recognizes Baló concentric sclerosis as a post-infectious complication of COVID-19 infection. It also demonstrates the severe progression of Baló concentric sclerosis and adds to the paucity of literature. Awareness of this rare and aggressive demyelinating disease is important to promptly treat patients and avoid disability.