Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
Gastroenterology Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
BMJ Case Rep. 2021 Feb 26;14(2):e238167. doi: 10.1136/bcr-2020-238167.
We present a case of 48-year-old woman with relapsing remitting multiple sclerosis (MS), who switched disease modifying therapy from Copaxone to Fingolimod due to her clinical and radiological MS disease progression. Unexpectedly after 2.5 years of stable MS symptoms and liver function tests (LFTs), we noted deranged LFTs during routine testing. Additional investigations showed hepatitis C positivity, genotype 3. It is likely a case of hepatitis C reactivation secondary to prolonged immunosuppressive effects of Fingolimod. Although the increased risk of viral reactivation related to varicella zoster virus is known to occur with Fingolimod treatment, to our knowledge, this is only the second case of hepatitis C disease activity reported with Fingolimod treatment. We would like to raise the awareness of hepatitis C viral reactivation as a possible complication of prolonged immunosuppression with Fingolimod.
我们报告了一例 48 岁女性复发性缓解型多发性硬化症（MS）患者，由于临床和影像学 MS 疾病进展，她将疾病修正治疗药物从 Copaxone 转换为芬戈莫德。出乎意料的是，在芬戈莫德稳定治疗 2.5 年后，我们在常规检查中发现肝功能检测异常。进一步检查显示丙型肝炎阳性，基因型 3。这可能是由于芬戈莫德的长期免疫抑制作用导致丙型肝炎再激活。虽然已知 Fingolimod 治疗会增加与水痘带状疱疹病毒相关的病毒再激活风险，但据我们所知，这是 Fingolimod 治疗后报告的第二例丙型肝炎疾病活动病例。我们希望提高对丙型肝炎病毒再激活作为 Fingolimod 长期免疫抑制的潜在并发症的认识。
