Extensive immune reconstitution inflammatory syndrome in Fingolimod-associated PML: a case report with 7 Tesla MRI data

BMC Neurol. 2019 Aug 9;19(1):190. doi: 10.1186/s12883-019-1407-2.

Abstract

Background: Progressive multifocal leukoencephalopathy (PML) is a rare complication of patients treated with fingolimod.

Case presentation: Routine MRI eventually led to diagnosis of asymptomatic early PML that remained stable after discontinuation of fingolimod. As blood lymphocyte counts normalized, signs of immune reconstitution inflammatory syndrome (IRIS) and renewed MS activity developed. Both, advanced laboratory and ultrahigh field MRI findings elucidated differences between PML and MS.

Conclusions: In our case, early discontinuation of fingolimod yielded a good outcome, lymphocyte counts reflected immune system activity, and paraclinical findings helped to differentiate between PML-IRIS and MS.

Keywords: 7 tesla MRI; Fingolimod; Immune reconstitution inflammatory syndrome; Multiple sclerosis; Progressive multifocal leucencephalopathy.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Fingolimod Hydrochloride / adverse effects*
  • Humans
  • Immune Reconstitution Inflammatory Syndrome / diagnostic imaging*
  • Immunosuppressive Agents / adverse effects*
  • Leukoencephalopathy, Progressive Multifocal / chemically induced*
  • Leukoencephalopathy, Progressive Multifocal / diagnostic imaging*
  • Magnetic Resonance Imaging / methods
  • Male
  • Multiple Sclerosis, Relapsing-Remitting / drug therapy

Substances

  • Immunosuppressive Agents
  • Fingolimod Hydrochloride