Retinal hemorrhages following fingolimod treatment for multiple sclerosis; a case report

BACKGROUND Fingolimod is the first oral agent used for treatment of relapsing-remitting multiple sclerosis. Macular edema, but not retinal hemorrhage, is a well-known adverse effect of fingolimod treatment. To the best of our knowledge, this is the first case report of extensive retinal hemorrhages following fingolimod treatment. CASE PRESENTATION A 31-year-old male with relapsing-remitting multiple sclerosis developed macular edema and retinal hemorrhages in his left eye, 1 month after starting fingolimod treatment; treatment was then discontinued. The hemorrhages were flame-shaped, and were extensive along retinal arteries and veins. The hemorrhages started to decrease at 4 weeks and disappeared completely at 24 weeks after cessation of fingolimod treatment. CONCLUSIONS Occurrence of retinal hemorrhage warrants careful follow-up for multiple sclerosis patients treated with fingolimod.