Abdul Moiz, initially presented to a tertiary care hospital in 2019 with complaints of B/L lower limb weakness, bladder and bowel incontinence. He underwent an MRI (Cervico-Dorsal Spine) which showed abnormal signal intensity in the intramedullary areas appearing hypointense on T1W1 and hyperintense on T2W2. He underwent 1 session of Plasma exchange therapy and received Methyl Prednisone followed by Rituximab to which he responded within a month. His IV Methylprednisone was tapered gradually, and he was started on Mycophenolate Mofetil and Hydochloroquine. Repeat MRI Scan (Cervical & Dorsal spine) showed a decrease in active lesions, and he was kept on 6-monthly Rituximab therapy.

Over 3 years, Abdul Moiz had frequent relapses and was treated with PLEX therapy, Methyl-prednisone and Rituximab. His symptoms responded for 1-2 months and relapsed again.

In Sept 2023, Abdul Moiz presented again with loss of bowel and bladder control and B/L lower limb weakness. His repeat MRI scan showed spinal cord atrophy with abnormal signal intensity from DV2-DV3 up til DV7-DV8. His Visual evoked potential testing showed a B/L decrease amplitude (axonal loss) and his CSF examination was negative for oligoclonal band and he had negative Anti Aquaporin 4 and Anti-Myelin Oligodendrocyte glycoprotein antibodies. He has again advised Methylprednisone and Rituximab therapy and was referred to AFBMTC for consideration of Auto-BMT.

The case was discussed in interdepartmental meetings including neurology and clinical haematology and considering the progressive nature of the disease and failure of multiple lines of therapy, it was decided to take him to Auto HCT. Stem cell mobilization was done and a CD34 dose of 19.8 x 10⁶/Kg was collected on 04/04/2024 and cryopreserved.

Abdul Moiz was admitted to AFBMTC for auto-BMT. At the time of admission, he had bilateral lower limb weakness and urinary hesitancy. The examination of lower limbs revealed normal muscle bulk, exaggerated reflexes, power 3/5 on the left leg and 2/5 on the right limb and a bilateral positive Babinski sign. His expanded disability status scale (EDSS) score was 6 at the time of admission.

He was transplanted on 13/5/24. Neutrophil engraftment was achieved on Day +09.

Moiz experienced febrile neutropenia, acute transfusion reaction with Random donor platelets and GTC seizures during transplant period.

He was discharged after his condition stabilized and wad advised for weekly follow up in OPD.