Case Report: Findings Suggestive of Paraclinical Progressive Multifocal Leukoencephalopathy and Lung Cancer-Derived Brain Metastases in an MS Patient Treated With Fingolimod
Fingolimod represents a highly effective disease-modifying drug in patients with active relapsing-remitting multiple sclerosis (RRMS). Its immunosuppressive effects can mediate adverse events like increased risk of cancer development or appearance of opportunistic infections. Progressive multifocal...
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doaj-dbbfd4dc4c604d61b2f27676f62413ca2021-02-03T05:41:58ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-02-011210.3389/fneur.2021.561158561158Case Report: Findings Suggestive of Paraclinical Progressive Multifocal Leukoencephalopathy and Lung Cancer-Derived Brain Metastases in an MS Patient Treated With FingolimodFabian Maass0Philipp von Gottberg1Jonas Franz2Christine Stadelmann3Mathias Bähr4Martin S. Weber5Martin S. Weber6Department of Neurology, University Medical Center Göttingen, Göttingen, GermanyDepartment of Neuroradiology, University Medical Center Göttingen, Göttingen, GermanyInstitute of Neuropathology, University Medical Center Göttingen, Göttingen, GermanyInstitute of Neuropathology, University Medical Center Göttingen, Göttingen, GermanyDepartment of Neurology, University Medical Center Göttingen, Göttingen, GermanyDepartment of Neurology, University Medical Center Göttingen, Göttingen, GermanyInstitute of Neuropathology, University Medical Center Göttingen, Göttingen, GermanyFingolimod represents a highly effective disease-modifying drug in patients with active relapsing-remitting multiple sclerosis (RRMS). Its immunosuppressive effects can mediate adverse events like increased risk of cancer development or appearance of opportunistic infections. Progressive multifocal leukoencephalopathy (PML)–representing a severe opportunistic infection–has been only infrequently described during Fingolimod treatment. Here, we present a case of a 63-year-old women with pre-diagnosed RRMS who presented with new multiple cerebral lesions in a routine MRI scan, also including a tumefactive lesion in the left parietal lobe, eventually leading to the diagnosis of brain metastases derived by an adenocarcinoma of the lung. Additionally, a JCV-DNA-PCR in the cerebrospinal fluid revealed positive results, corresponding to a paraclinical progressive multifocal leukoencephalopathy. In conclusion, adverse events potentially associated with immunosuppression can occur during Fingolimod treatment. In this context, the occurrence of cancer and opportunistic infections should be carefully monitored. Here, we report a case in which JCV-DNA-PCR in the cerebrospinal fluid suggests asymptomatic PML and simultaneously lung cancer brain metastases developed. While it is rather unlikely that either event occurred as an adverse event of fingolimod treatment, a contributing effect cannot be formally excluded.https://www.frontiersin.org/articles/10.3389/fneur.2021.561158/fullmultiple sclerosisfingolimod (FTY720)lung cancerRRMS (relapsing-Remitting MS)PML–progressive multifocal leucoencephalopathy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Fabian Maass Philipp von Gottberg Jonas Franz Christine Stadelmann Mathias Bähr Martin S. Weber Martin S. Weber |
spellingShingle |
Fabian Maass Philipp von Gottberg Jonas Franz Christine Stadelmann Mathias Bähr Martin S. Weber Martin S. Weber Case Report: Findings Suggestive of Paraclinical Progressive Multifocal Leukoencephalopathy and Lung Cancer-Derived Brain Metastases in an MS Patient Treated With Fingolimod Frontiers in Neurology multiple sclerosis fingolimod (FTY720) lung cancer RRMS (relapsing-Remitting MS) PML–progressive multifocal leucoencephalopathy |
author_facet |
Fabian Maass Philipp von Gottberg Jonas Franz Christine Stadelmann Mathias Bähr Martin S. Weber Martin S. Weber |
author_sort |
Fabian Maass |
title |
Case Report: Findings Suggestive of Paraclinical Progressive Multifocal Leukoencephalopathy and Lung Cancer-Derived Brain Metastases in an MS Patient Treated With Fingolimod |
title_short |
Case Report: Findings Suggestive of Paraclinical Progressive Multifocal Leukoencephalopathy and Lung Cancer-Derived Brain Metastases in an MS Patient Treated With Fingolimod |
title_full |
Case Report: Findings Suggestive of Paraclinical Progressive Multifocal Leukoencephalopathy and Lung Cancer-Derived Brain Metastases in an MS Patient Treated With Fingolimod |
title_fullStr |
Case Report: Findings Suggestive of Paraclinical Progressive Multifocal Leukoencephalopathy and Lung Cancer-Derived Brain Metastases in an MS Patient Treated With Fingolimod |
title_full_unstemmed |
Case Report: Findings Suggestive of Paraclinical Progressive Multifocal Leukoencephalopathy and Lung Cancer-Derived Brain Metastases in an MS Patient Treated With Fingolimod |
title_sort |
case report: findings suggestive of paraclinical progressive multifocal leukoencephalopathy and lung cancer-derived brain metastases in an ms patient treated with fingolimod |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Neurology |
issn |
1664-2295 |
publishDate |
2021-02-01 |
description |
Fingolimod represents a highly effective disease-modifying drug in patients with active relapsing-remitting multiple sclerosis (RRMS). Its immunosuppressive effects can mediate adverse events like increased risk of cancer development or appearance of opportunistic infections. Progressive multifocal leukoencephalopathy (PML)–representing a severe opportunistic infection–has been only infrequently described during Fingolimod treatment. Here, we present a case of a 63-year-old women with pre-diagnosed RRMS who presented with new multiple cerebral lesions in a routine MRI scan, also including a tumefactive lesion in the left parietal lobe, eventually leading to the diagnosis of brain metastases derived by an adenocarcinoma of the lung. Additionally, a JCV-DNA-PCR in the cerebrospinal fluid revealed positive results, corresponding to a paraclinical progressive multifocal leukoencephalopathy. In conclusion, adverse events potentially associated with immunosuppression can occur during Fingolimod treatment. In this context, the occurrence of cancer and opportunistic infections should be carefully monitored. Here, we report a case in which JCV-DNA-PCR in the cerebrospinal fluid suggests asymptomatic PML and simultaneously lung cancer brain metastases developed. While it is rather unlikely that either event occurred as an adverse event of fingolimod treatment, a contributing effect cannot be formally excluded. |
topic |
multiple sclerosis fingolimod (FTY720) lung cancer RRMS (relapsing-Remitting MS) PML–progressive multifocal leucoencephalopathy |
url |
https://www.frontiersin.org/articles/10.3389/fneur.2021.561158/full |
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