Reactions 1704, p163 - 2 Jun 2018
Severe aseptic temporal lobe encephalitis: case
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
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
Reactions 2 Jun 2018 No. 17040114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved