Q: 42 year male who developed acute Transverse Myelitis - failed treatment options with high dose steroids and plasma exchange . What could be your third salvage option?

Answer: Intravenous cyclophosphamide

If there is continued progression despite high dose IV steroid  and Plasma Exchange therapy, pulse dose of intravenous cyclophosphamide (800–1000 mg/m2) can be given with consultation of neurology and oncology services.