# A 62-Year-Old Male Patient With Spinal Lesions Following Fingolimod Discontinuation in the Setting of Disseminated Shingles

## TL;DR

An older man with MS had severe flare-ups after stopping fingolimod due to shingles, suggesting a possible rebound effect.

## Contribution

This case highlights a potential rebound effect of discontinuing fingolimod in MS patients.

## Key findings

- The patient experienced two severe MS exacerbations within six weeks of stopping fingolimod.
- Disseminated zoster infection led to discontinuation of long-term fingolimod treatment.
- The case raises suspicion of early fingolimod-associated rebound despite possible confounding infections.

## Abstract

The association between the discontinuation of therapies and “rebound” multiple sclerosis (MS) activity has been frequently reported, yet is incompletely understood. We report an older male with previously well-controlled MS who was taken off his decade-long fingolimod treatment due to disseminated zoster infection, who subsequently experienced two severe MS exacerbations within six weeks. Though clinicians should consider possible confounding influences from infections such as varicella-zoster virus (VZV) and COVID-19, this case raised the most concern for suspicion of early fingolimod-associated rebound.