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Progressive multifocal leukoencephalopathy or immune reconstitution inflammatory syndrome after fingolimod cessation? A case report.
- Source :
-
BMC Neurology . 8/19/2022, Vol. 22 Issue 1, p1-6. 6p. - Publication Year :
- 2022
-
Abstract
- <bold>Background: </bold>Fingolimod is associated with an increased risk of developing progressive multifocal leukoencephalopathy (PML); however, its discontinuation may cause severe immune reconstitution inflammatory syndrome (IRIS). As both of these conditions (especially fingolimod induced PML) are rarely described in medical case reports distinguishing between PML-IRIS and MS-IRIS may be diagnostically challenging.<bold>Case Presentation: </bold>We report a patient with severe clinical decline (Expanded Disability Status Scale (EDSS) increasing from 3.5 to 7.5) and multiple, large, contrast-enhancing lesions on brain magnetic resonance imaging (MRI) a few months after fingolimod withdrawal. The diagnostic possibilities included IRIS due to fingolimod withdrawal versus PML-IRIS. The JC virus (JCV) antibody index was positive (2.56); however, cerebrospinal fluid (CSF) JCV real-time polymerase chain reaction (JCV-PCR) was negative and brain biopsy was not performed. After a long course of aggressive treatment (several pulsed methylprednisolone infusions, plasmapheresis, intravenous dexamethasone, oral mirtazapine) the patient gradually recovered (EDSS 2.5) and MRI lesions decreased.<bold>Conclusions: </bold>This case report demonstrates the importance of monitoring patients carefully after the discontinuation of fingolimod for PML-IRIS and rebound MS with IRIS as these conditions may manifest similarly. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 14712377
- Volume :
- 22
- Issue :
- 1
- Database :
- Academic Search Index
- Journal :
- BMC Neurology
- Publication Type :
- Academic Journal
- Accession number :
- 158651224
- Full Text :
- https://doi.org/10.1186/s12883-022-02839-3