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Published on: February 28, 2021
Tumefactive MS lesions under fingolimod: a case report and literature review
Georg Pilz1, Andrea Harrer, Peter Wipfler
1From the Department of Neurology (G.P., A.H., P.W., K.O., J.S., E.T., J.K.), Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria; the Department of Neurology (J.S.), Klinikum rechts der Isar, Technische Universität München, Germany; and the Department of Neurology (F.F.), Medical University of Graz, Austria.
Objective:
To report about a possible association between fingolimod treatment and tumefactive demyelinating lesions (TDL) as seen in a patient developing repeated TDL on continued fingolimod therapy.
Methods:
We performed serial clinical and radiologic assessments and immunophenotyping of blood and CSF immune cells. We also present a literature review about recent similar cases.
Results:
Clinical course and radiologic findings were consistent with diagnosis of TDL. Immune cell phenotyping showed pronounced shifts in the immune cell composition related to fingolimod treatment. In addition, we observed a subset of highly differentiated effector cells (CD45R0negCCR7neg) within the CD8+ T-cell population, which was about 2-fold enriched in the CSF compared to the peripheral blood.
Conclusion:
Our observations add further evidence for the development of atypical demyelinating lesions in some patients receiving fingolimod. These might be related to a treatment-associated shift in the immunopathology of specifically susceptible individuals.
