Glioblastoma Multiforme in Multiple Sclerosis: A Diagnostic Challenge

Background: The concurrence of long-standing multiple sclerosis (MS) and glioblastoma multiforme (GBM) is a well-documented phenomenon that has been presented in a number of case reports. However, due to the clinical and radiographic resemblance between GBM and an acute MS exacerbation, GBM in this setting remains a diagnostic challenge that is often missed in its early stages. No clear consensus has been made regarding predisposing risk factors or identifiable associations between GBM and MS. Prior hypotheses suggest a possible role for immunosuppression,  tumor growth in areas of MS plaques, and/or de novo tumor occurrence although science is still lacking in these areas due to rarity of this concurrence. 

Objectives: To present a diagnostically-challenging case of glioblastoma multiforme in a patient with long-standing relapsing remitting multiple sclerosis (RRMS).

Methods: Case Report: We present a case of GBM presenting as a worsening left hemiparesis in a patient with long-standing RRMS. Cerebral MRI showed a contrast-enhancing lesion in the right periventricular white matter, initially attributed to MS exacerbation and treated with intravenous steroids with improvement of symptoms.

Results: Within two weeks of discharge, the patient developed complex partial seizures with repeat imaging revealing rapid growth of contrast-enhancing lesion. Biopsy of the lesion confirmed the diagnosis of GBM.

Conclusions: Recognition of the possibility of central nervous system (CNS) tumors in patients with previously-diagnosed MS is important because it presents a diagnostic dilemma. In addition, early recognition may alter the course of management in such patients and potentially patient outcome. Our case presents insight into these diagnostically-challenging cases as well as raises further question regarding the association between disease modifying treatment (DMT) and CNS tumors. Additionally, we provide a literature review of GBS in MS.