Sharma Ishta, Abdulhussein Dalia, Minakaran Neda, Harvey Joshua
Medicine, King's College London, London, UK
King's College Hospital NHS Foundation Trust, London, UK.
BMJ Case Rep. 2024 Dec 22;17(12):e261377. doi: 10.1136/bcr-2024-261377.
A man in his 20s with a background of relapsing-remitting multiple sclerosis developed spinal cryptococcosis and choroiditis after 8 years of therapy with the oral immunomodulator fingolimod. The osseous cryptococcosis was diagnosed with a vertebral biopsy, after radiological changes in the C5 vertebra were incidentally identified during routine biannual neuroimaging. He was subsequently admitted for intravenous antifungal therapy. During admission, the patient reported bilateral floaters and was subsequently found to have bilateral choroidal lesions suggestive of a partially treated cryptococcal choroiditis with normal vision. This case is, to our knowledge, the first report of cryptococcal choroiditis secondary to fingolimod therapy and reaffirms the importance of a high index of clinical suspicion of ocular infections in the setting of chronic immunosuppression.
一名20多岁、有复发缓解型多发性硬化病史的男性，在接受口服免疫调节剂芬戈莫德治疗8年后发生了脊柱隐球菌病和脉络膜炎。在每半年进行一次的常规神经影像学检查中偶然发现C5椎体有放射学改变后，经椎体活检确诊为骨隐球菌病。随后他入院接受静脉抗真菌治疗。住院期间，患者报告有双侧飞蚊症，随后被发现有双侧脉络膜病变，提示为视力正常的部分治疗性隐球菌性脉络膜炎。据我们所知，该病例是芬戈莫德治疗继发隐球菌性脉络膜炎的首例报告，再次强调了在慢性免疫抑制情况下对眼部感染保持高度临床怀疑的重要性。
