Fingolimod-related cryptococcal meningoencephalitis and immune reconstitution inflammatory syndrome in a patient with multiple sclerosis

Mult Scler Relat Disord. 2021 Aug:53:103072. doi: 10.1016/j.msard.2021.103072. Epub 2021 Jun 5.

Abstract

Fingolimod is an oral medication for multiple sclerosis that sequesters certain subsets of lymphocytes in lymph nodes, reducing egress into blood and their subsequent CNS migration. The initial multi-site randomized Phase III controlled trials found rates of infection similar to those in control groups. However, post-marketing surveillance has revealed an association with several opportunistic infections, including cryptococcosis. We report a case of fingolimod-related cryptococcal meningoencephalitis and IRIS after drug discontinuation and suggest a surveillance and risk mitigation strategy.

Keywords: Cryptococcal meningoencephalitis; Fingolimod; Immune reconstitution inflammatory syndrome; Multiple sclerosis.

Publication types

  • Case Reports
  • Letter

MeSH terms

  • Fingolimod Hydrochloride / adverse effects
  • Humans
  • Immune Reconstitution Inflammatory Syndrome* / chemically induced
  • Immune Reconstitution Inflammatory Syndrome* / complications
  • Immunosuppressive Agents / adverse effects
  • Meningitis, Cryptococcal* / drug therapy
  • Meningoencephalitis* / chemically induced
  • Multiple Sclerosis* / complications
  • Multiple Sclerosis* / drug therapy

Substances

  • Immunosuppressive Agents
  • Fingolimod Hydrochloride