Abstract
AbstractBackgroundDimethyl fumarate (DMF) was the second oral disease‐modifying drug to be approved for multiple sclerosis (MS) in Japan, after fingolimod. Switching from fingolimod to DMF treatment is becoming increasingly common, because DMF has shown a better risk–benefit profile and an equivalent efficacy to fingolimod.Case presentationWe report a 35‐year‐old woman who was positive for anti‐John Cunningham virus antibody and who developed severe rebound relapse of MS after switching from fingolimod to DMF. Five months after starting DMF treatment, she had a severe relapse attack with disseminated lesions in the cerebrum and cervical spinal cord. Furthermore, subsequent relapse attacks occurred with new lesions in the thoracic spinal cord, even during repeated steroid pulse therapies and plasma exchanges. The disease activity finally ceased after natalizumab administration.ConclusionsSwitching from fingolimod to DMF carries the risk of MS reactivation and rebound. Natalizumab treatment for a limited period might be recommended to treat MS rebound in anti‐John Cunningham virus antibody‐positive patients.
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