Abstract
Background: Delayed-release dimethyl fumarate (DMF) treatment can be associated with reduced lymphocyte and leucocyte counts, which might persist after DMF discontinuation. Case presentation: We report the case of a patient with severe disease reactivation despite prolonged lymphopenia after DMF discontinuation. We describe the frequency and impact of prolonged lymphopenia after DMF discontinuation at two tertiary MS centres. A 36-year-old female patient with multiple sclerosis was switched to DMF after 14 years of treatment with interferon beta-1a. DMF was suspended after 4 months because of persistent lymphopenia for 3 months. Six months later, the patient had a severe relapse with multiple enhancing brain lesions at MRI although lymphopenia was still persistent. Haematological assessment excluded other causes of lymphopenia, which was evaluated as a probable iatrogenic complication of DMF. The patient was treated with i.v. methylprednisolone 1 gr daily for 3 days with clinical recovery. Conclusions: Prolonged lymphopenia after DMT discontinuation does not protect against disease reactivation. Starting a new immune therapy should be balanced against the option of a “wait and see.” A different immunotherapeutic strategy such as an anti-B therapeutic approach could be considered.
Original language | English |
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Pages (from-to) | 623-625 |
Number of pages | 3 |
Journal | Acta Neurologica Scandinavica |
Volume | 137 |
Issue number | 6 |
DOIs |
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Publication status | Published - Jun 1 2018 |
Keywords
- demyelinating diseases
- dimethyl fumarate
- lymphopenia
- multiple sclerosis
- neurodegenerative disorders
- relapse
ASJC Scopus subject areas
- Neurology
- Clinical Neurology