Fingolimod

Fingolimod Reactions 1704, p163 - 2 Jun 2018 Severe aseptic temporal lobe encephalitis: case report A 49-year-old woman developed severe aseptic temporal lobe encephalitis during treatment with fingolimod for relapsing-remitting multiple sclerosis (RRMS). The woman, who had been on fingolimod for 3.5 years [route and dosage not stated] for a 25-year history of RRMS, presented with global aphasia, confusion and holocephalic headache. Additionally, she had been receiving treatment with an angiotensin-II receptor blocker and a proton pump inhibitor [specific drugs not stated]. She had a decline in consciousness within 12 hours of admission, indicated by a Glasgow coma score of 10, and low-grade fever. Her lymphocyte count was low. Baseline Expanded Disability Status Scale was 2 on account of mild cognitive deficits. MRI showed oedema in her bilateral temporal and inferior frontal lobes with patchy gadolinium enhancement, as well as extensive, poorly-defined increased T2 signal. Her protein levels were elevated on day 1. Cryptococcal antibody, bacterial culture and viral PCR were negative. Her blood tests were negative for lyme, HIV and VDRL. A differential diagnosis of aseptic encephalitis was made. Fingolimod was discontinued, and the woman was commenced on systemic antibiotics including ampicillin, vancomycin and ceftriaxone, in combination with acyclovir. She recovered quickly. Her consciousness level returned to normal within 24 hours, and she was able to communicate within 3 days. A few days later on day 8, her protein levels remained mildly elevated. Viral PCRs and cultures were again negative. One month later at a follow-up, her Montreal Cognitive Assessment score was 28/30. A repeat MRI revealed a regression of lesions. Author comment: "Here we describe a case of severe aseptic temporal lobe encephalitis mimicking [herpes simplex virus] encephalitis which occurred on the licensed dose of Rotstein DL, et al. Severe aseptic temporal lobe encephalitis on fingolimod. Multiple Sclerosis and Related Disorders 23: 4-6, Jul 2018. Available from: URL: http://doi.org/10.1016/j.msard.2018.04.008 - Canada 803322993 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Reactions Weekly Springer Journals

Fingolimod

Reactions Weekly , Volume 1704 (1) – Jun 2, 2018
Free
1 page
Loading next page...
1 Page
 
/lp/springer_journal/fingolimod-0U4CezDzEe
Publisher
Springer International Publishing
Copyright
Copyright © 2018 by Springer International Publishing AG, part of Springer Nature
Subject
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
ISSN
0114-9954
eISSN
1179-2051
D.O.I.
10.1007/s40278-018-46806-8
Publisher site
See Article on Publisher Site

Abstract

Reactions 1704, p163 - 2 Jun 2018 Severe aseptic temporal lobe encephalitis: case report A 49-year-old woman developed severe aseptic temporal lobe encephalitis during treatment with fingolimod for relapsing-remitting multiple sclerosis (RRMS). The woman, who had been on fingolimod for 3.5 years [route and dosage not stated] for a 25-year history of RRMS, presented with global aphasia, confusion and holocephalic headache. Additionally, she had been receiving treatment with an angiotensin-II receptor blocker and a proton pump inhibitor [specific drugs not stated]. She had a decline in consciousness within 12 hours of admission, indicated by a Glasgow coma score of 10, and low-grade fever. Her lymphocyte count was low. Baseline Expanded Disability Status Scale was 2 on account of mild cognitive deficits. MRI showed oedema in her bilateral temporal and inferior frontal lobes with patchy gadolinium enhancement, as well as extensive, poorly-defined increased T2 signal. Her protein levels were elevated on day 1. Cryptococcal antibody, bacterial culture and viral PCR were negative. Her blood tests were negative for lyme, HIV and VDRL. A differential diagnosis of aseptic encephalitis was made. Fingolimod was discontinued, and the woman was commenced on systemic antibiotics including ampicillin, vancomycin and ceftriaxone, in combination with acyclovir. She recovered quickly. Her consciousness level returned to normal within 24 hours, and she was able to communicate within 3 days. A few days later on day 8, her protein levels remained mildly elevated. Viral PCRs and cultures were again negative. One month later at a follow-up, her Montreal Cognitive Assessment score was 28/30. A repeat MRI revealed a regression of lesions. Author comment: "Here we describe a case of severe aseptic temporal lobe encephalitis mimicking [herpes simplex virus] encephalitis which occurred on the licensed dose of Rotstein DL, et al. Severe aseptic temporal lobe encephalitis on fingolimod. Multiple Sclerosis and Related Disorders 23: 4-6, Jul 2018. Available from: URL: http://doi.org/10.1016/j.msard.2018.04.008 - Canada 803322993 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704

Journal

Reactions WeeklySpringer Journals

Published: Jun 2, 2018

References

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off