Tumefactive Multiple Sclerosis in a Patient on Fingolimod (P2.226)

Objective: To report a rare complication of fingolimod treatment in a patient with multiple sclerosis (MS) Background: Fingolimod is a promising novel oral disease modifying therapy (DMT) for multiple sclerosis. Tumefactive MS is an extremely rare complication of fingolimod treatment with only a few cases reported. We report a further case of tumefactive MS in a patient treated with fingolimod. Design: Case Report 42-year-old lady with a seven year history of relapsing remitting multiple sclerosis (RRMS) and hypothyroidism presented with a three day history of progressive confusion, severe sensory-motor dysphasia and right sided hemiparesis. She was on an interferon for 3 years and changed to fingolimod 3 months prior to her presentation because of an ongoing relapses. Her only other medication was levothyroxine. Neurological examination revealed right sided hemiparesis with a severe expressive and receptive dysphasia. Her MRI brain, with MR spectroscopy, diffusion weighted, perfusion and ADC map imaging showed extensive left sided space occupying lesion involving frontal, temporal and parietal lobes with contrast enhancement and a degree of midline shift suggestive of tumefactive MS. Her CSF showed inflammatory changes with negative infective and cytopathology screen. Vasculitic and autoantibody screen was negative. She received a course of intravenous Methylprednisolone, 1g a day for 5 days, followed by tapering dose of oral prednisolone over several weeks. She underwent plasma exchange over 5 days. Results: She recovered very well clinically and her subsequent MRI’s showed steady improvement of the inflammatory changes. She started second line disease modifying drug Tysabri 10 weeks after her initial presentation. Conclusion: We discussed clinical presentation, radiological characteristics, and response to treatment in this patient with tumefactive MS on fingolimod. We speculate on possible causes and suggest more research into this rare phenomenon. We stress importance of pharmacovigilance in all novel therapies. Disclosure: Dr. Lee has nothing to disclose. Dr. Sawlani has nothing to disclose. Dr. Mazibrada has received personal compensation for activities with Biogen Idec, Novartis and Merck Serono as a speaker and advisory board member.