Fulminant multifocal relapse in a fingolimod-treated multiple sclerosis patient

G Breville; A M Lascano; D Merkler; S Roth; P H Lalive

doi:10.1016/j.msard.2019.06.017

Fulminant multifocal relapse in a fingolimod-treated multiple sclerosis patient

Mult Scler Relat Disord. 2019 Sep:34:63-65. doi: 10.1016/j.msard.2019.06.017. Epub 2019 Jun 17.

Authors

G Breville¹, A M Lascano², D Merkler³, S Roth⁴, P H Lalive⁵

Affiliations

¹ Department of Neurosciences, Division of Neurology, Geneva University Hospital, Geneva, Switzerland. Electronic address: gautier.breville@hcuge.ch.
² Department of Neurosciences, Division of Neurology, Geneva University Hospital, Geneva, Switzerland. Electronic address: agustina.lascano@hcuge.ch.
³ Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Clinical Pathology, Geneva University Hospital, 1211 Geneva, Switzerland. Electronic address: doron.merkler@hcuge.ch.
⁴ Department of Neurosciences, Division of Neurology, Geneva University Hospital, Geneva, Switzerland. Electronic address: serge.roth@latour.ch.
⁵ Department of Neurosciences, Division of Neurology, Geneva University Hospital, Geneva, Switzerland; Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland. Electronic address: patrice.lalive@hcuge.ch.

PMID: 31229736
DOI: 10.1016/j.msard.2019.06.017

Abstract

Background: Fingolimod is the first approved oral disease-modifying treatment for relapsing-remitting multiple sclerosis. Fingolimod targets lymphocytes, exerting a modulator effect on cell-surface sphingosine-1-phosphate receptors and thus blocking lymphocytes egression from secondary lymphoid organs. Recent reports describe fingolimod cessation being followed by severe or pseudo-tumoral relapse, but it usually does not happen on continuous long-term treatment.

Case presentation: Here we present the case of a patient on continuous long-term fingolimod treatment who presented with fulminant atypical multifocal relapse involving over 30 new and active lesions.

Conclusion: This case is unique since this fulminant multifocal relapse occurred in a patient with grade 3 lymphopenia and irreproachable adherence. This observation should be known as a possible side effect of fingolimod treatment.

Keywords: Fingolimod; Relapse; Relapsing remitting multiple sclerosis.

Publication types

Case Reports

MeSH terms

Adult
Female
Fingolimod Hydrochloride / therapeutic use*
Humans
Immunosuppressive Agents / therapeutic use*
Lymphopenia / etiology
Multiple Sclerosis, Relapsing-Remitting / diagnostic imaging
Multiple Sclerosis, Relapsing-Remitting / pathology
Multiple Sclerosis, Relapsing-Remitting / therapy*
Natalizumab / therapeutic use
Treatment Adherence and Compliance

Substances

Immunosuppressive Agents
Natalizumab
Fingolimod Hydrochloride