Cutaneous cryptococcosis in a patient taking fingolimod for multiple sclerosis: Here come the opportunistic infections?

Mult Scler. 2017 Feb;23(2):297-299. doi: 10.1177/1352458516670732.

Abstract

Background: Fingolimod is an oral disease-modifying therapy for relapsing forms of multiple sclerosis, which acts by sequestering lymphocytes within lymph nodes.

Objective: To describe a case of extrapulmonary cryptococcosis in a patient taking fingolimod.

Methods: Case report.

Results: A 47-year-old man developed a non-healing skin lesion approximately 16 months after starting treatment with fingolimod. Biopsy revealed cryptococcosis. Fingolimod was discontinued and the lesion resolved with antifungal therapy.

Conclusion: Despite few reported opportunistic infections in the pivotal clinical trials and first few years post-marketing, there has been a recent increase in reported AIDS-defining illnesses in patients taking fingolimod. Neurologists should be alert for opportunistic infections in their patients using this medication.

Keywords: AIDS; Cryptococcosis; cutaneous; fingolimod; multiple sclerosis; skin.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Cryptococcosis / diagnosis
  • Cryptococcosis / drug therapy*
  • Fingolimod Hydrochloride / adverse effects
  • Fingolimod Hydrochloride / therapeutic use*
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Male
  • Middle Aged
  • Multiple Sclerosis / drug therapy*
  • Opportunistic Infections / diagnosis
  • Opportunistic Infections / drug therapy*
  • Recurrence

Substances

  • Immunosuppressive Agents
  • Fingolimod Hydrochloride