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Case Report: Persisting Lymphopenia During Neuropsychiatric Tumefactive Multiple Sclerosis Rebound Upon Fingolimod Withdrawal

Fingolimod (FTY) is a disease modifying therapy for relapsing remitting multiple sclerosis (RRMS) which can lead to severe lymphopenia requiring therapy discontinuation in order to avoid adverse events. However, this can result in severe disease reactivation occasionally presenting with tumefactive...

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Autores principales: Koska, Valeria, Förster, Moritz, Brouzou, Katja, Arat, Ercan, Albrecht, Philipp, Aktas, Orhan, Küry, Patrick, Meuth, Sven G., Kremer, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8585856/
https://www.ncbi.nlm.nih.gov/pubmed/34777236
http://dx.doi.org/10.3389/fneur.2021.785180
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author Koska, Valeria
Förster, Moritz
Brouzou, Katja
Arat, Ercan
Albrecht, Philipp
Aktas, Orhan
Küry, Patrick
Meuth, Sven G.
Kremer, David
author_facet Koska, Valeria
Förster, Moritz
Brouzou, Katja
Arat, Ercan
Albrecht, Philipp
Aktas, Orhan
Küry, Patrick
Meuth, Sven G.
Kremer, David
author_sort Koska, Valeria
collection PubMed
description Fingolimod (FTY) is a disease modifying therapy for relapsing remitting multiple sclerosis (RRMS) which can lead to severe lymphopenia requiring therapy discontinuation in order to avoid adverse events. However, this can result in severe disease reactivation occasionally presenting with tumefactive demyelinating lesions (TDLs). TDLs, which are thought to originate from a massive re-entry of activated lymphocytes into the central nervous system, are larger than 2 cm in diameter and may feature mass effect, perifocal edema, and gadolinium enhancement. In these cases, it can be challenging to exclude important differential diagnoses for TDLs such as progressive multifocal leukoencephalopathy (PML) or other opportunistic infections. Here, we present the case of a 26-year-old female patient who suffered a massive rebound with TDLs following FTY discontinuation with primarily neuropsychiatric symptoms despite persisting lymphopenia. Two cycles of seven plasmaphereses each were necessary to achieve remission and ocrelizumab was used for long-term stabilization.
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spelling pubmed-85858562021-11-13 Case Report: Persisting Lymphopenia During Neuropsychiatric Tumefactive Multiple Sclerosis Rebound Upon Fingolimod Withdrawal Koska, Valeria Förster, Moritz Brouzou, Katja Arat, Ercan Albrecht, Philipp Aktas, Orhan Küry, Patrick Meuth, Sven G. Kremer, David Front Neurol Neurology Fingolimod (FTY) is a disease modifying therapy for relapsing remitting multiple sclerosis (RRMS) which can lead to severe lymphopenia requiring therapy discontinuation in order to avoid adverse events. However, this can result in severe disease reactivation occasionally presenting with tumefactive demyelinating lesions (TDLs). TDLs, which are thought to originate from a massive re-entry of activated lymphocytes into the central nervous system, are larger than 2 cm in diameter and may feature mass effect, perifocal edema, and gadolinium enhancement. In these cases, it can be challenging to exclude important differential diagnoses for TDLs such as progressive multifocal leukoencephalopathy (PML) or other opportunistic infections. Here, we present the case of a 26-year-old female patient who suffered a massive rebound with TDLs following FTY discontinuation with primarily neuropsychiatric symptoms despite persisting lymphopenia. Two cycles of seven plasmaphereses each were necessary to achieve remission and ocrelizumab was used for long-term stabilization. Frontiers Media S.A. 2021-10-29 /pmc/articles/PMC8585856/ /pubmed/34777236 http://dx.doi.org/10.3389/fneur.2021.785180 Text en Copyright © 2021 Koska, Förster, Brouzou, Arat, Albrecht, Aktas, Küry, Meuth and Kremer. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Koska, Valeria
Förster, Moritz
Brouzou, Katja
Arat, Ercan
Albrecht, Philipp
Aktas, Orhan
Küry, Patrick
Meuth, Sven G.
Kremer, David
Case Report: Persisting Lymphopenia During Neuropsychiatric Tumefactive Multiple Sclerosis Rebound Upon Fingolimod Withdrawal
title Case Report: Persisting Lymphopenia During Neuropsychiatric Tumefactive Multiple Sclerosis Rebound Upon Fingolimod Withdrawal
title_full Case Report: Persisting Lymphopenia During Neuropsychiatric Tumefactive Multiple Sclerosis Rebound Upon Fingolimod Withdrawal
title_fullStr Case Report: Persisting Lymphopenia During Neuropsychiatric Tumefactive Multiple Sclerosis Rebound Upon Fingolimod Withdrawal
title_full_unstemmed Case Report: Persisting Lymphopenia During Neuropsychiatric Tumefactive Multiple Sclerosis Rebound Upon Fingolimod Withdrawal
title_short Case Report: Persisting Lymphopenia During Neuropsychiatric Tumefactive Multiple Sclerosis Rebound Upon Fingolimod Withdrawal
title_sort case report: persisting lymphopenia during neuropsychiatric tumefactive multiple sclerosis rebound upon fingolimod withdrawal
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8585856/
https://www.ncbi.nlm.nih.gov/pubmed/34777236
http://dx.doi.org/10.3389/fneur.2021.785180
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