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Current HIV Research

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ISSN (Print): 1570-162X
ISSN (Online): 1873-4251

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Case Report

A Case of Fingolimod-associated Cryptococcal Meningitis

Author(s): Ilad Alavi Darazam*, Mohammad Mahdi Rabiei, Omid Moradi, Farid Javandoust Gharehbagh, Mehrdad Roozbeh, Ramin Nourinia, Firouze Hatami, Maziar Shojaei and Legha Lotfollahi

Volume 20, Issue 4, 2022

Published on: 03 September, 2022

Page: [337 - 342] Pages: 6

DOI: 10.2174/1570162X20666220629124225

Price: $65

Abstract

Background: Leukopenia, a rare adverse effect of Fingolimod therapy, paves the way for opportunistic infections. In this study, we reported rare fingolimod associated cryptococcal meningitis.

Case Presentation: 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.

Conclusion: 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.

Keywords: Multiple sclerosis, relapsing-remitting multiple sclerosis, fingolimod, cryptococcal meningitis, central nervous system. 1. INTRODUCTION

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