Exacerbations in multiple sclerosis are treated with short courses of high dose intravenous methylprednisolone. Treatment with intravenous methylprednisolone has mainly minor side effects such as transient flushing, a brief disturbance of taste, insomnia, and mild weight gain.1 An anaphylactoid reaction after intravenous methylprednisolone treatment has been described in only one patient with multiple sclerosis.2 We report on a patient with multiple sclerosis who developed an anaphylactoid reaction on high dose intravenous methylprednisolone treatment. Additional investigations were performed to elucidate the mechanism of this reaction to intravenous methylprednisolone.

A 44 year old woman was admitted to our clinic because of progressive multiple sclerosis. One year before admission she had developed paresis of the legs, and subsequently of the arms. She became incontinent for urine and faeces. On admission she also complained of numb feelings and muscle cramps in her legs. The medical history mentioned hypertension for which she used propranolol and hydrochlorothiazide. The family history was negative for multiple sclerosis. On examination there was vertical nystagmus, slight paresis of the arms, paraplegia, incoordination of the arms, and loss of sensation from a mid-thoracic level. The tendon reflexes of the legs were very brisk, …