# Situation: A 30-year-old woman with relapsing-remitting multiple sclerosis (MS) comes to the neurology clinic. She was diagnosed 2 years ago and now takes interferon beta injections and oral baclofen for leg spasticity. Last week she had burning on urination and a temperature of 38.5 °C, and the old numbness and weakness in her legs got worse. Both returned to her usual level within 2 days after her urinary tract infection was treated, and no new symptom appeared. How should the nurse classify this episode?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629927  
> language: ko  
> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 30-year-old woman with relapsing-remitting multiple sclerosis (MS) comes to the neurology clinic. She was diagnosed 2 years ago and now takes interferon beta injections and oral baclofen for leg spasticity.

Last week she had burning on urination and a temperature of 38.5 °C, and the old numbness and weakness in her legs got worse. Both returned to her usual level within 2 days after her urinary tract infection was treated, and no new symptom appeared. How should the nurse classify this episode?

## 보기

1. A pseudo-relapse that needs no change in her therapy **✔ 정답**
2. A new relapse with spread of disease to the bladder
3. A true relapse that needs high-dose corticosteroids
4. Progression to a secondary progressive disease course

**정답: 1**

## 해설

A pseudo-relapse is a temporary worsening of old symptoms caused by heat, fever, infection (often a urinary tract infection), or stress, and it settles when the trigger is treated. A true relapse is a new or worsening symptom lasting more than 24 hours without fever or infection. Her symptoms were old ones, occurred with fever, and resolved with treatment of the infection.

## 심화 해설

Classification of the episode

The correct classification is pseudo-relapse, which requires no modification of the disease-modifying therapy or acute corticosteroid treatment.

A pseudo-relapse is a transient reappearance or worsening of pre-existing neurological symptoms triggered by a systemic stressor such as fever, infection, dehydration, or heat exposure. In this case, the patient experienced burning on urination and a temperature of 38.5 °C, both consistent with a urinary tract infection. Her old symptoms of leg numbness and weakness worsened during the febrile period and then returned to baseline within 2 days after the infection was treated. No new neurological deficit appeared.

A true MS relapse is defined by new or worsening neurological symptoms lasting more than 24 hours in the absence of fever or infection. Because this patient’s symptoms were old, occurred in the setting of fever and infection, and resolved once the trigger was eliminated, the episode does not meet the criteria for a true relapse. Consequently, high-dose corticosteroids are not indicated, and there is no evidence of disease progression to a secondary progressive course.

Key point! Fever itself can impair conduction through previously demyelinated axons. Elevated body temperature slows or blocks saltatory conduction in areas where the myelin sheath is already damaged, causing old symptoms to resurface temporarily. This is a physiological phenomenon, not new inflammatory disease activity.

Watch out! Urinary tract infections are among the most common triggers of pseudo-relapse in persons with MS. The evaluation of any suspected relapse should therefore include a search for infection, fever, or metabolic derangement before concluding that new inflammatory activity has occurred [2].

The distinction between relapse and pseudo-relapse carries direct treatment implications. A true relapse that is functionally bothersome may warrant timely corticosteroid therapy to accelerate recovery and limit disability [2]. A pseudo-relapse, by contrast, is managed by treating the underlying trigger. Changing the disease-modifying regimen or administering steroids in this scenario would expose the patient to unnecessary risk without addressing the actual cause of the transient worsening.

| Feature | Pseudo-relapse | True relapse |
| --- | --- | --- |
| Symptoms | Old symptoms reappear or worsen | New symptoms or clear worsening of old ones |
| Trigger | Fever, infection, heat, stress | No identifiable systemic trigger |
| Duration | Variable; resolves when trigger is treated | Persists beyond 24 hours |
| Pathophysiology | Conduction block in previously demyelinated axons | New inflammatory demyelination |
| Treatment | Treat the underlying trigger | Consider corticosteroids if functionally significant |

Infections are recognized as being associated with an increased risk of both relapse and pseudo-relapse in individuals with MS . The clinical challenge is to determine which process is occurring in a given patient. When fever and infection are present, the safest initial interpretation is that the neurological worsening represents a pseudo-relapse until proven otherwise. The patient’s rapid return to her usual baseline after treatment of the urinary tract infection confirms this interpretation.References (research sources)

- [2]Therapeutic management of severe relapses in multiple sclerosis.Research articleBevan C, Gelfand JM (2015) · DOI: 10.1007/s11940-015-0345-6

## 임상 시나리오

MS Pseudo-Relapse vs True RelapseFever or infection can unmask old deficits without new disease activity
A pseudo-relapse is a temporary return or worsening of old MS symptoms caused by a systemic stressor such as fever, infection, heat, or dehydration. It resolves when the trigger is treated and does not require changing disease-modifying therapy or giving corticosteroids.

A true relapse is defined as new or worsening neurological symptoms lasting more than 24 hours in the absence of fever or infection. This patient had only old symptoms, a temperature of 38.5 °C, and a urinary tract infection, and returned to baseline within 2 days after treatment.

Elevated body temperature can slow or block conduction through previously demyelinated axons, causing old deficits to reappear. This is a physiological phenomenon, not new inflammatory activity.

CautionDo not give high-dose corticosteroids for a pseudo-relapse. First identify and treat the underlying trigger, most often a urinary tract infection, then reassess neurological status.

## 핵심 개념

- **pseudo-relapse** — Transient worsening of old MS symptoms triggered by fever, infection, heat, or stress that resolves when the trigger is removed
- **true relapse** — New or worsening neurological symptoms lasting more than 24 hours in the absence of fever or infection
- **Uhthoff phenomenon** — Temporary worsening of neurological symptoms caused by increased body temperature impairing conduction in demyelinated axons
- **disease-modifying therapy** — Long-term MS treatment such as interferon beta that reduces relapse rate and disease activity

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