Service de Maladies Infectieuses et Tropicales. Hôpitaux Civils de Colmar, 39 avenue de la liberté, 68024, Colmar, France.
Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg Cedex, France.
BMC Infect Dis. 2020 Mar 30;20(1):257. doi: 10.1186/s12879-020-04988-7.
Cryptosporidium sp. are common intracellular parasites responsible of severe diarrhea in T-cell-immunocompromised patients. We report the first case of a woman who contracted cryptosporidiosis after treatment with fingolimod, a drug labeled for multiple sclerosis and responsible for marked lymphopenia.
A 60-year-old woman was admitted for abdominal pain diarrhea and fever. The patient suffered from multiple sclerosis and had been treated with fingolimod from august 2017 to september 2018 time of occurrence of the first digestive symptoms. Stool culture was negative but parasitological examination was positive for Cryptosporidium sp. Blood biological examination profound lymphopenia of 240/mm [17 CD4/mm (7%) and 32 CD8/mm (14%)]. Fingolimod was stopped, and the patient was put on nitazoxanide 500 mg bid for 7 days. The diarrhea resolved and no relapse was observed. Six other cases were found in the Pharmacovigilance database.
Physicians should be aware of this association and screen for Cryptosporidium in cases of diarrhea in patients treated with fingolimod. Patients should be aware of this risk and advise to take appropriate measures to avoid such contamination.
隐孢子虫是常见的细胞内寄生虫，可导致 T 细胞免疫功能低下的患者发生严重腹泻。我们报告了首例接受芬戈莫德治疗后感染隐孢子虫病的病例，芬戈莫德是一种被批准用于多发性硬化症的药物，可导致显著的淋巴细胞减少。
一名 60 岁女性因腹痛、腹泻和发热而入院。该患者患有多发性硬化症，曾于 2017 年 8 月至 2018 年 9 月期间接受芬戈莫德治疗，首次出现消化系统症状。粪便培养阴性，但寄生虫检查阳性提示隐孢子虫感染。血液生化检查显示严重的淋巴细胞减少，计数为 240/mm³[17 CD4/mm³（7%）和 32 CD8/mm³（14%）]。停用芬戈莫德，给予患者硝唑尼特 500mg，每日 2 次，共 7 天。腹泻缓解，未再复发。在药物警戒数据库中还发现了另外 6 例病例。
医生应意识到这种关联，并在接受芬戈莫德治疗的患者出现腹泻时筛查隐孢子虫。患者应意识到这种风险，并建议采取适当措施避免这种感染。
