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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...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2021
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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. |
format | Online Article Text |
id | pubmed-8585856 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
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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