title: Fingolimod-induced leukoencephalopathy in a patient with neuromyelitis optica spectrum disorder.
abstract: Fingolimod (FTY720) is used for reducing the annualized relapse rate and slowing progression of neurological disability in relapsing-remitting forms of multiple sclerosis (MS). However, its safety is not confirmed in patients with neuromyelitis optica spectrum disorder (NMOSD), who characteristically have positive aquaporin-4 (AQP-4) antibody. A 54-year-old female with a relapsing-remitting course of optic neuritis and myelitis for six years, diagnosed initially as MS, had been treated with interferon beta-1b and oral corticosteroid. Magnetic resonance imaging (MRI) consistently revealed lesions on the optic nerve and spinal cord, but never on the brainstem or cerebral white matter during acute exacerbation. After treatment was switched to fingolimod from interferon beta-1b, multiple new lesions appeared at the brainstem and cerebral white matter. Following discontinuation of fingolimod, these lesions completely cleared, concomitantly with clinical improvement. During fingolimod treatment, she was recognized to be positive for AQP-4 antibody. Fingolimod may be contraindicated in patients with NMOSD.
authors.affiliation: Department of Neurology, Tokai University Oiso Hospital, 21-1 Gakkyou, Oiso, Naka-gun, Kanagawa 259-0198, Japan. Electronic address: yoshii@is.icc.u-tokai.ac.jp.
authors.forename: Fumihito
authors.initials: F
authors.lastname: Yoshii
authors.affiliation: Department of Neurology, Tokai University Oiso Hospital, 21-1 Gakkyou, Oiso, Naka-gun, Kanagawa 259-0198, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Moriya
authors.affiliation: Department of Neurology, Tokai University Oiso Hospital, 21-1 Gakkyou, Oiso, Naka-gun, Kanagawa 259-0198, Japan.
authors.forename: Tomohide
authors.initials: T
authors.lastname: Ohnuki
authors.affiliation: Department of Neurology, Tokai University Oiso Hospital, 21-1 Gakkyou, Oiso, Naka-gun, Kanagawa 259-0198, Japan.
authors.forename: Masafuchi
authors.initials: M
authors.lastname: Ryo
authors.affiliation: Department of Neurology, Tokai University Oiso Hospital, 21-1 Gakkyou, Oiso, Naka-gun, Kanagawa 259-0198, Japan.
authors.forename: Wakoh
authors.initials: W
authors.lastname: Takahashi
mesh_terms: D051401:Aquaporin 4 / Q000276:immunology; D001921:Brain / Q000000981:diagnostic imaging; D005260:Female; D000068876:Fingolimod Hydrochloride / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D056784:Leukoencephalopathies / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000276:immunology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology; D013116:Spinal Cord / Q000000981:diagnostic imaging
chemical_list: C496030:AQP4 protein, human; D051401:Aquaporin 4; D007166:Immunosuppressive Agents; D000068876:Fingolimod Hydrochloride
keywords: Fingolimod; Leukoencephalopathy; MRI; Multiple sclerosis; Neuromyelitis optica spectrum disorder