Yuen Hiu Lam Agnes, Brown Susan, Chan Noel, Grigoriadis George
Department of Haematology, Monash Health, Clayton, Victoria, Australia.
Department of Clinical Haematology, Monash University, Melbourne, Victoria, Australia.
BMJ Case Rep. 2017 Sep 11;2017:bcr-2017-220590. doi: 10.1136/bcr-2017-220590.
Fingolimod is an oral sphingosine-1-phosphate receptor modulator which causes lymphocyte sequestration in lymph nodes and is approved for relapsing multiple sclerosis. The Therapeutic Goods Administration of Australia is aware of only one case where fingolimod preceded immune thrombocytopenic purpura (ITP) by 5 weeks. Here we report three such cases.None were on any medications known to cause ITP and routine investigations were unremarkable. All cases were treated with immunosuppression. Case 1 successfully weaned prednisolone after fingolimod cessation whereas case 2 weaned slowly while continuing fingolimod therapy. Case 3 had more refractory ITP and re-exposure to fingolimod worsened thrombocytopenia.There was a temporal association between fingolimod exposure and ITP however dose-effect association and pathogenesis remain less clear.In conclusion, our cases highlight that clinicians should be aware of the possible association between ITP and fingolimod.
芬戈莫德是一种口服的鞘氨醇-1-磷酸受体调节剂，可使淋巴细胞滞留于淋巴结，已被批准用于复发型多发性硬化症。澳大利亚治疗用品管理局仅知晓1例在免疫性血小板减少性紫癜（ITP）出现前5周使用芬戈莫德的病例。在此，我们报告3例此类病例。所有病例均未服用已知可导致ITP的药物，常规检查也无异常。所有病例均接受了免疫抑制治疗。病例1在停用芬戈莫德后成功停用泼尼松龙，而病例2在继续芬戈莫德治疗的同时缓慢减药。病例3的ITP更难治，再次接触芬戈莫德使血小板减少症恶化。芬戈莫德暴露与ITP之间存在时间关联，然而剂量效应关联和发病机制仍不太明确。总之，我们的病例强调临床医生应意识到ITP与芬戈莫德之间可能存在的关联。
