{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:06:25Z","timestamp":1753891585542,"version":"3.41.2"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T00:00:00Z","timestamp":1612310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>Fingolimod represents a highly effective disease-modifying drug in patients with active relapsing-remitting multiple sclerosis (RRMS). Its immunosuppressive effects can mediate adverse events like increased risk of cancer development or appearance of opportunistic infections. Progressive multifocal leukoencephalopathy (PML)\u2013representing a severe opportunistic infection\u2013has been only infrequently described during Fingolimod treatment. Here, we present a case of a 63-year-old women with pre-diagnosed RRMS who presented with new multiple cerebral lesions in a routine MRI scan, also including a tumefactive lesion in the left parietal lobe, eventually leading to the diagnosis of brain metastases derived by an adenocarcinoma of the lung. Additionally, a JCV-DNA-PCR in the cerebrospinal fluid revealed positive results, corresponding to a paraclinical progressive multifocal leukoencephalopathy. In conclusion, adverse events potentially associated with immunosuppression can occur during Fingolimod treatment. In this context, the occurrence of cancer and opportunistic infections should be carefully monitored. Here, we report a case in which JCV-DNA-PCR in the cerebrospinal fluid suggests asymptomatic PML and simultaneously lung cancer brain metastases developed. While it is rather unlikely that either event occurred as an adverse event of fingolimod treatment, a contributing effect cannot be formally excluded.<\/jats:p>","DOI":"10.3389\/fneur.2021.561158","type":"journal-article","created":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T06:18:39Z","timestamp":1612333119000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Case Report: Findings Suggestive of Paraclinical Progressive Multifocal Leukoencephalopathy and Lung Cancer-Derived Brain Metastases in an MS Patient Treated With Fingolimod"],"prefix":"10.3389","volume":"12","author":[{"given":"Fabian","family":"Maass","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"von Gottberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonas","family":"Franz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Stadelmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathias","family":"B\u00e4hr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin S.","family":"Weber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,2,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"101335","DOI":"10.1016\/j.msard.2019.07.011","article-title":"Early initiation of fingolimod reduces the rate of severe relapses over the long term: Post hoc analysis from the FREEDOMS, FREEDOMS II, and TRANSFORMS studies","volume":"36","author":"Haas","year":"2019","journal-title":"Mult Scler Relat Disord."},{"key":"B2","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1056\/NEJMoa0907839","article-title":"Oral fingolimod or intramuscular interferon for relapsing multiple sclerosis","volume":"362","author":"Cohen","year":"2010","journal-title":"N Engl J Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e1815","DOI":"10.1212\/WNL.0000000000005529","article-title":"Progressive multifocal leukoencephalopathy after fingolimod treatment","volume":"90","author":"Berger","year":"2018","journal-title":"Neurology"},{"key":"B4","first-page":"172","article-title":"[MRI aspects of progressive multifocal leukoencephalopathy]","volume":"22","author":"Sarrazin","year":"1995","journal-title":"J Neuroradiol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1007\/BF00313922","article-title":"The clinical relevance of locally produced carcinoembryonic antigen in cerebrospinal fluid","volume":"233","author":"Jacobi","year":"1986","journal-title":"J Neurol."},{"key":"B6","first-page":"314","article-title":"Carcinoembryonic antigen in the CSF of cancer patients\u2013the value of intrathecal synthesis and correlation with IgA-diffusion dynamics","volume":"110","author":"Moldrich","year":"2010","journal-title":"Acta Neurol Belg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1002\/emmm.201201283","article-title":"Sphingosine analogue drug FTY720 targets I2PP2A\/SET and mediates lung tumour suppression via activation of PP2A-RIPK1-dependent necroptosis","volume":"5","author":"Saddoughi","year":"2013","journal-title":"EMBO Mol Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1002\/ana.25701","article-title":"Cancer risk for fingolimod, natalizumab, and rituximab in multiple sclerosis patients","volume":"87","author":"Alping","year":"2020","journal-title":"Ann 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