Extensive white matter lesions after 2 years of fingolimod: progressive multifocal leukoencephalopathy or MS relapse?

Abstract : Fingolimod is a widely used treatment for highly active relapsing multiple sclerosis (RR MS). Here we report the case of a 27-year-old MS patient treated for more than two years by fingolimod, who presented severe hemiplegia and speech disturbances associated with extensive white matter lesions on brain MRI. Although initial presentation questioned the possibility of progressive multifocal leukoencephalopathy, final diagnosis was MS relapse and appropriate treatment resulted in clinical and radiological improvement. Severe MS relapses under fingolimod have been reported, but late onset after treatment initiation and extensive subcortical topography are unusual, and represent a diagnostic challenge.
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Marine Boudot de la Motte, Céline Louapre, Anne Bertrand, Pauline Reach, Catherine Lubetzki, et al.. Extensive white matter lesions after 2 years of fingolimod: progressive multifocal leukoencephalopathy or MS relapse?. Multiple Sclerosis Journal, SAGE Publications, 2017, 23 (4), pp.614 - 616. ⟨10.1177/1352458516682858⟩. ⟨hal-01562641⟩

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