Cryptococcal meningitis causing obstructive hydrocephalus in a patient on fingolimod

Area of Science:

• Neurology
• Infectious Diseases
• Immunology

Background:

• Fingolimod is an immunomodulating drug used for multiple sclerosis.
• Opportunistic infections like cryptococcosis are risks in immunocompromised individuals.

Observation:

• A case of cryptococcal meningitis with obstructive hydrocephalus in a patient on fingolimod therapy is presented.
• The meningitis caused posterior fossa leptomeningeal inflammation and cerebellar edema, leading to fourth ventricle effacement.

Findings:

• The patient required urgent ventriculostomy for obstructive hydrocephalus.
• Antifungal therapy and subsequent ventriculoperitoneal shunt placement successfully managed the hydrocephalus and ventriculomegaly.

Implications:

• This case highlights a rare but severe complication of fingolimod-induced immunosuppression.
• Increased awareness is crucial for clinicians as fingolimod use expands.