福米苷酯治疗 2 年后广泛的脑白质病变：进行性多灶性脑白质病还是 MS 复发？
Extensive white matter lesions after 2 years of fingolimod: Progressive multifocal leukoencephalopathy or MS relapse?
机构信息
Neurology Department, Pitié-Salpêtrière Hospital, APHP, Paris, France.
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.
出版信息
Mult Scler. 2017 Apr;23(4):614-616. doi: 10.1177/1352458516682858. Epub 2016 Dec 14.
BACKGROUND
Fingolimod is a widely used treatment for highly active relapsing-remitting multiple sclerosis.
OBJECTIVES
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.
CONCLUSION
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.
背景
芬戈莫德是一种广泛用于治疗活跃复发缓解型多发性硬化症的药物。
目的
描述一名 27 岁患者的病例，该患者使用芬戈莫德治疗超过 2 年，出现偏瘫和言语障碍，同时大脑磁共振成像（MRI）显示广泛的白质病变。
方法
病例研究。
结果
尽管最初的表现提示进行性多灶性白质脑病的可能性，但最终诊断为多发性硬化症（MS）复发。适当的治疗导致了临床和影像学的改善。
结论
已经报道了在芬戈莫德治疗下出现严重的 MS 复发，但在治疗开始后很晚才出现且广泛的皮质下病变是不常见的，这构成了诊断上的挑战。
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