Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Curr HIV Res. 2022;20(4):337-342. doi: 10.2174/1570162X20666220629124225.
Leukopenia, a rare adverse effect of Fingolimod therapy, paves the way for opportunistic infections. In this study, we reported rare fingolimod associated cryptococcal meningitis.
A 39-year-old woman with RRMS was referred to the emergency department. The patient's major complaints were headache, fever, weakness, and progressive loss of consciousness within the last two days prior to the referral. The patient had a history of hospitalization due to RRMS [two times]. In the second hospitalization, interferon Beta-1a was replaced with Fingolimod. Using polymerase chain reaction, Cryptococcus neoformans was detected in CSF. Liposomal amphotericin B and fluconazole [800 mg per day] were started. Six weeks later, the patient was discharged without any major complaints.
Albeit fingolimod associated cryptococcal meningitis is a rare event, Fingolimod therapy in patients with MS should be performed cautiously. Regular follow-ups may give rise to a timely diagnosis of probable fingolimod associated cryptococcal meningitis. Fingolimod therapy can lead to lymphocytopenia and various infections. We, therefore, suggest that intermittent blood lymphocyte counts as well as monitoring of clinical manifestations among MS patients treated with Fingolimod to avoid additional neurological and physical disabilities in these patients.
白细胞减少症是芬戈莫德治疗的一种罕见不良反应，为机会性感染铺平了道路。本研究报告了一种罕见的与芬戈莫德相关的隐球菌性脑膜炎。
一位 39 岁的 RRMS 女性患者被转至急诊部。患者的主要主诉是头痛、发热、乏力，并在转诊前两天内逐渐丧失意识。该患者曾因 RRMS 住院[两次]。第二次住院时，干扰素 Beta-1a 被芬戈莫德取代。通过聚合酶链反应，在 CSF 中检测到新型隐球菌。开始使用两性霉素 B 脂质体和氟康唑[每天 800mg]。六周后，患者无明显不适出院。
尽管与芬戈莫德相关的隐球菌性脑膜炎是一种罕见事件，但在 MS 患者中使用芬戈莫德治疗时应谨慎进行。定期随访可能会及时诊断出可能与芬戈莫德相关的隐球菌性脑膜炎。芬戈莫德治疗可导致淋巴细胞减少和各种感染。因此，我们建议在接受芬戈莫德治疗的 MS 患者中进行间断性血淋巴细胞计数和临床表现监测，以避免这些患者出现额外的神经和身体残疾。
