Progressive Multifocal Leukoencephalopathy and Immune Reconstitution Inflammatory Syndrome after Discontinuation of Fingolimod

Raquel Piñar Morales; María Carrasco Garcia; Luis Gutierrez-Rojas; Francisco Javier Barrero Hernández

doi:10.1159/000521944

Progressive Multifocal Leukoencephalopathy and Immune Reconstitution Inflammatory Syndrome after Discontinuation of Fingolimod

Case Rep Neurol. 2022 Feb 7;14(1):38-43. doi: 10.1159/000521944. eCollection 2022 Jan-Apr.

Authors

Raquel Piñar Morales^{1

2}, María Carrasco Garcia¹, Luis Gutierrez-Rojas^{2

3}, Francisco Javier Barrero Hernández^{1

2}

Affiliations

¹ Servicio de Neurología, Hospital Clínico Universitario San Cecilio, Granada, Spain.
² Departamento Medicina, Universidad de Granada, Granada, Spain.
³ Unidad de Salud Mental, Hospital Clínico Universitario San Cecilio, Granada, Spain.

Abstract

Progressive multifocal leukoencephalopathy (PML) is a rare complication of immunosuppressive treatment in MS patients. Immune reconstitution inflammatory syndrome (IRIS) appears after the withdrawal of certain drugs such as natalizumab (NTZ) or fingolimod. The development of PML-IRIS after NTZ treatment has been described, and its diagnosis is made by clinical and radiological criteria and the determination of the John Cunningham virus in CSF. We present a clinical case of a patient with MS who, after the withdrawal of fingolimod, developed PML-IRIS despite sustained lymphopenia. This is important for pharmacovigilance purposes, not only for NTZ but also for alternative drugs used in MS treatment.

Keywords: Fingolimod; Immune reconstitution inflammatory syndrome; Magnetic resonance imaging; Multiple sclerosis; Progressive multifocal leukoencephalopathy.

Publication types

Case Reports