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Updated: Jan 21, 2026
Cardiac Magnetic Resonance Imaging at 7 Tesla
Published on: January 6, 2019
Extensive immune reconstitution inflammatory syndrome in Fingolimod-associated PML: a case report with 7 Tesla MRI
Tim Sinnecker1,2, Jeffrie Hadisurya3, Tilman Schneider-Hohendorf4
1Department of Neurology, Universitätsspital, Basel, Switzerland.
Background:
Progressive multifocal leukoencephalopathy (PML) is a rare complication of patients treated with fingolimod.
Case Presentation:
Routine MRI eventually led to diagnosis of asymptomatic early PML that remained stable after discontinuation of fingolimod. As blood lymphocyte counts normalized, signs of immune reconstitution inflammatory syndrome (IRIS) and renewed MS activity developed. Both, advanced laboratory and ultrahigh field MRI findings elucidated differences between PML and MS.
Conclusions:
In our case, early discontinuation of fingolimod yielded a good outcome, lymphocyte counts reflected immune system activity, and paraclinical findings helped to differentiate between PML-IRIS and MS.
Insights
Early discontinuation of fingolimod for progressive multifocal leukoencephalopathy (PML) led to a good outcome. Immune reconstitution inflammatory syndrome (IRIS) and multiple sclerosis (MS) activity were differentiated using advanced diagnostics.
Area of Science:
- Neuroimmunology
- Neurology
- Radiology
Background:
- Progressive multifocal leukoencephalopathy (PML) is a rare but serious complication associated with fingolimod therapy.
- Understanding PML in the context of immunomodulatory treatments is crucial for patient management.
Observation:
- A case of asymptomatic early PML was diagnosed via routine MRI in a patient treated with fingolimod.
- Discontinuation of fingolimod led to PML stability, but normalization of lymphocyte counts triggered immune reconstitution inflammatory syndrome (IRIS) and new multiple sclerosis (MS) activity.
Findings:
- Advanced laboratory tests and ultrahigh field MRI were instrumental in differentiating between PML and MS.
- Lymphocyte counts served as an indicator of immune system recovery and activity.
Implications:
- Early detection and discontinuation of fingolimod can lead to favorable outcomes in PML.
- Distinguishing PML-IRIS from MS is critical for appropriate treatment strategies.
- Integrated diagnostic approaches combining imaging and laboratory findings are essential for managing complex neurological conditions.
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