A Case of Severe Multiple Sclerosis Reactivation Following Fingolimod Cessation
Objectives: Here we report the case of a young woman who experienced severe consecutive clinical relapses with profound MRI activity, following FGD discontinuation.
Methods: Case History
Results: A 36 year-old woman with a history of RRMS was started on FGD in April 2011 after previously having been on IFN-β 1a. Her baseline lymphocyte count(LC) on FGD was 400. In 05/2015, she stopped FGD in order to conceive. Approximately 3 months later, she experienced at least two clinical relapses, each refractory to treatment with IV steroids. In 10/2015, she restarted FGD but remained symptomatic and was subsequently admitted for plasma exchange(PLEX). Her symptoms persisted post PLEX and repeat MRI studies revealed innumerable enhancing lesions throughout the brain, cervical and thoracic spine. At this time, her LC's were around 500. The patient was readmitted and treated with Rituximab. The patient was transferred to an inpatient rehabilitation facility, where she currently remains.
Conclusions: The severity of rebound in this case highlights the need to better understand the consequence of lymphocyte redistribution, the rate of immune recovery, and factors involved in immune regulation.
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