Fingolimod-induced bladder lymphoma in a patient with multiple sclerosis

A Case of Primary Central Nervous System Lymphoma That Developed in a Patient Receiving Fingolimod Therapy for Multiple Sclerosis

Fingolimod is an oral medication for the prevention of multiple sclerosis relapse, and its efficacy has been demonstrated in several clinical trials. Fingolimod has various side effects, such as arrhythmia and hepatic dysfunction. In addition, there have been rare reports of the development of lymphoproliferative disorders in patients undergoing fingolimod therapy, including primary central nervous system lymphoma (PCNSL). We diagnosed and treated a multiple sclerosis patient who developed PCNSL while undergoing fingolimod therapy. Fourteen months after starting fingolimod therapy, the patient developed aphasia, and underwent biopsy analysis for a lesion displaying a homogeneous gadolinium-enhanced lesion in the left frontal lobe. The lesion was diagnosed as diffuse large B-cell lymphoma by pathological examination. After the diagnosis, the patient received chemotherapy together with methotrexate combination therapy, and the lesion became smaller and the patient's symptoms improved. Although several autopsy cases of PCNSL in patients who received fingolimod therapy have been reported, there have been few reports to date of patients diagnosed by biopsy analysis.