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
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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