Fingolimod/yellow fever vaccine
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Rebound effect in the form of fulminant multiple sclerosis reactivation: case report A 37-year-old woman exhibited rebound effect in the form of fulminant multiple sclerosis (MS) reactivation following administration of yellow fever vaccine and discontinuation of fingolimod. The woman, who had been diagnosed with relapsingremitting MS in 2010, started receiving fingolimod in 2014 following switch from glatiramer acetate treatment. In July 2018, she discontinued fingolimod because of her travel plans. Two months later, she received yellow fever vaccine [routes and dosages not stated]. After 2 months, she presented with sensorimotor hemiparesis. Her symptoms occurred one week following yellow fever vaccine administration. The woman was hospitalised and treated with methylprednisolone and plasma exchange. She responded to the treatment, and she was discharged. After 2 months, she exhibited another relapse along with tetraparesis, aphasia, dysphagia and conjugated gaze palsy. Cranial MRI revealed massive, new and enlarged T2-FLAIR along with gadolinium enhanced lesions. Cerebrospinal fluid analysis showed a blood-brain barrier disturbance with lymphocytic pleocytosis as well as increased intrathecal IgG and IgM synthesis. New oligoclonal bands were observed, suggesting an activation of B-cell/plasma cell mediated auto-reactivity. She then received natalizumab. Thereafter, her clinical and MRI disease course significantly improved, and intrathecal IgG and IgM synthesis normalised. It was concluded that she exhibited rebound effect of fingolimod withdrawal in the form of fulminant MS reactivation triggered by yellow fever vaccine. Author comment: "Here, we report a severe rebound after [fingolimod] withdrawal due to further perturbation of the immune system by live vaccination." "In summary, our case indicates that (I) in the context of [fingolimod] withdrawal, MS relapses can be triggered by live attenuated vaccines". Rolfes L, et al. Fulminant MS reactivation following combined fingolimod cessation and yellow fever vaccination. International Journal of Molecular Sciences 20: No. 23, 28 Nov 2019. Available from: URL: http://doi.org/10.3390/ 803442536 ijms20235985 - Germany
0114-9954/20/1785-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 4 Jan 2020 No. 1785
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