Severe multiple sclerosis reactivation during prolonged lymphopenia after dimethyl fumarate discontinuation

C. Zecca, C. G. Antozzi, V. Torri Clerici, M. Ferrazzini, R. E. Mantegazza, S. Rossi, C. Gobbi

Research output: Contribution to journalComment/debate

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 languageEnglish
Pages (from-to)623-625
Number of pages3
JournalActa Neurologica Scandinavica
Volume137
Issue number6
DOIs
Publication statusPublished - Jun 1 2018

Keywords

  • demyelinating diseases
  • dimethyl fumarate
  • lymphopenia
  • multiple sclerosis
  • neurodegenerative disorders
  • relapse

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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