title: Extensive white matter lesions after 2 years of fingolimod: Progressive multifocal leukoencephalopathy or MS relapse?
abstract: BACKGROUND
  Fingolimod is a widely used treatment for highly active relapsing-remitting multiple sclerosis.
  
  
  OBJECTIVE
  To describe the case of a 27-year-old patient treated for more than 2 years by Fingolimod, who presented hemiplegia and speech disturbances associated with extensive white matter lesions on brain magnetic resonance imaging (MRI).
  
  
  METHODS
  Case study.
  
  
  RESULTS
  Although initial presentation questioned the possibility of progressive multifocal leukoencephalopathy, final diagnosis was multiple sclerosis (MS) relapse. Appropriate treatment resulted in clinical and radiological improvement.
  
  
  CONCLUSIONS
  Severe MS relapses under Fingolimod have been reported, but late onset after treatment initiation and extensive subcortical topography is unusual and represents a diagnostic challenge.
authors.affiliation: Neurology Department, Pitié-Salpêtrière Hospital, APHP, Paris, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Boudot de la Motte
authors.affiliation: Neurology Department, Pitié-Salpêtrière Hospital, APHP, Paris, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Louapre
authors.affiliation: Diagnostic and Functional Neuroradiology Department, Pitié-Salpêtrière Hospital, APHP, Paris, France/Inserm U1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Inria Paris-Rocquencourt, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Bertrand
authors.affiliation: Neurology Department, Pitié-Salpêtrière Hospital, APHP, Paris, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Reach
authors.affiliation: Neurology Department, Pitié-Salpêtrière Hospital, APHP, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lubetzki
authors.affiliation: Neurology Department, Pitié-Salpêtrière Hospital, APHP, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Papeix
authors.affiliation: Neurology Department, Pitié-Salpêtrière Hospital, APHP, Paris, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Maillart
mesh_terms: D000068876:Fingolimod Hydrochloride / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000188:drug therapy* / Q000473:pathology; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D000069442:Natalizumab / Q000627:therapeutic use*; D016896:Treatment Outcome; D066127:White Matter / Q000187:drug effects / Q000473:pathology*
chemical_list: D007166:Immunosuppressive Agents; D000069442:Natalizumab; D000068876:Fingolimod Hydrochloride
keywords: MRI; Multiple sclerosis; fingolimod; progressive multifocal leukoencephalopathy