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• Description of the development of tumefactive demyelinating lesion under fingolimod. • There has been an increasing number of reports describing the above. • This has not been seen in other immune modifying drugs used in multiple sclerosis. A 38-year-old man with relapsing remitting multiple sclerosis (RRMS) developed a tumefactive demyelinating lesion (TDL) after being clinically and radiologically stable on fingolimod for the last five years. TDLs in MS tend to occur early on in the disease and are uncommon in longstanding MS. Compared to other immune modifying drugs used in MS, there is a relatively high and still increasing number of reports describing the development of TDL under treatment with fingolimod, suggesting a causal relation. [ABSTRACT FROM AUTHOR]