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Cryptococcal meningitis after fingolimod discontinuation in a patient with multiple sclerosis
Melanie D Ward1, David E Jones1, Myla D Goldman1
1Department of Neurology, University of Virginia, PO Box 800394, Charlottesville, VA 22908, USA.
Multiple Sclerosis and Related Disorders
|September 21, 2016
Summary
Fingolimod, a multiple sclerosis drug, can cause serious infections like cryptococcal meningitis. This report details the first case of this infection occurring after a patient stopped taking fingolimod.
Area of Science:
- Neurology
- Infectious Diseases
- Pharmacology
Background:
- Fingolimod is an oral sphingosine-1-phosphate analogue used for relapsing multiple sclerosis (MS).
- Fingolimod treatment is linked to lymphopenia and increased herpes infection risk.
- Post-marketing surveillance identified cases of cryptococcal meningitis associated with fingolimod.
Observation:
- This report presents the first case of cryptococcal meningitis diagnosed after fingolimod discontinuation.
- All previously reported cases were associated with active fingolimod treatment.
Findings:
- Cryptococcal meningitis can occur even after discontinuing fingolimod therapy.
- The risk of infection may persist beyond the active treatment period.
Implications:
- This finding necessitates a re-evaluation of infection monitoring protocols for patients previously treated with fingolimod.
- Clinicians should maintain a high index of suspicion for opportunistic infections like cryptococcosis in patients with a history of fingolimod use.
- Further research is needed to understand the duration of this risk and inform long-term patient management strategies.
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