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

BACKGROUND

Fingolimod is a widely used treatment for highly active relapsing-remitting multiple sclerosis.

OBJECTIVES

To describe the case of a 27-year-old patient treated for more than 2 years by Fingolimod, who presented hemiplegia and speech disturbances associated with extensive white matter lesions on brain magnetic resonance imaging (MRI).

METHODS

Case study.

RESULTS

Although initial presentation questioned the possibility of progressive multifocal leukoencephalopathy, final diagnosis was multiple sclerosis (MS) relapse. Appropriate treatment resulted in clinical and radiological improvement.

CONCLUSION

Severe MS relapses under Fingolimod have been reported, but late onset after treatment initiation and extensive subcortical topography is unusual and represents a diagnostic challenge.