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