Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil.
Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas Departamento de Neurologia, São Paulo, São Paulo, Brazil.
Rev Inst Med Trop Sao Paulo. 2024 Jul 8;66:e39. doi: 10.1590/S1678-9946202466039. eCollection 2024.
Fingolimod is a sphingosine-1-phosphate receptor modulator used to treat multiple sclerosis. While fingolimod has been associated with an increased risk of cryptococcal meningitis, its correlation with other deep mycoses remains unclear. In this study, we conducted a scoping review of fingolimod associated with histoplasmosis, based on a case report, a literature review, and data from the FDA Adverse Events Reporting System (FAERS) as of January 24th, 2023. A 30-year-old Brazilian woman diagnosed with relapsing-remitting multiple sclerosis, receiving a daily dose of 0.5 mg of fingolimod, presented with a two-month history of fever and unintended weight loss, accompanied by lymphadenopathy, splenomegaly, and lung involvement was investigated. Biopsy of a lung nodule revealed fungal structures suggestive of Histoplasma sp. Additionally, serological testing yielded positive for Histoplasma capsulatum. Disseminated histoplasmosis should be considered in the differential diagnosis of febrile syndromes in patients undergoing fingolimod therapy for multiple sclerosis, particularly in the Americas, where this mycosis is endemic. Treatment with itraconazole and modification of immunotherapy can achieve excellent clinical outcomes.
芬戈莫德是一种鞘氨醇-1-磷酸受体调节剂，用于治疗多发性硬化症。虽然芬戈莫德与隐球菌性脑膜炎的风险增加有关，但它与其他深部真菌感染的相关性尚不清楚。在这项研究中，我们根据病例报告、文献综述以及截至 2023 年 1 月 24 日美国食品和药物管理局不良事件报告系统（FAERS）的数据，对与组织胞浆菌病相关的芬戈莫德进行了范围界定审查。一名 30 岁的巴西女性被诊断患有复发缓解型多发性硬化症，每天接受 0.5 毫克芬戈莫德治疗，出现发热和意外体重减轻两个月，伴有淋巴结病、脾肿大和肺部受累。对肺结节进行活检显示出真菌结构，提示为组织胞浆菌。此外，血清学检测呈荚膜组织胞浆菌阳性。对于正在接受芬戈莫德治疗多发性硬化症的患者出现发热综合征时，应考虑播散性组织胞浆菌病作为鉴别诊断，特别是在组织胞浆菌病流行的美洲地区。伊曲康唑治疗和免疫疗法的修改可以实现良好的临床结果。
