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Fingolimod-related cryptococcal meningoencephalitis and immune reconstitution inflammatory syndrome in a patient with

Fernando X Cuascut1, Samir Alkabie1, George J Hutton1

  • 1Maxine Mesinger Multiple Sclerosis Comprehensive Care Center, Department of Neurology, Baylor College of Medicine, Houston, Texas, United States.

Multiple Sclerosis and Related Disorders
|June 17, 2021
PubMed

Insights

Fingolimod, an oral multiple sclerosis drug, can lead to serious opportunistic infections like cryptococcosis. This case highlights the need for careful monitoring and risk management strategies, especially after discontinuing the medication.

Area of Science:

  • Neuroimmunology
  • Infectious Diseases
  • Pharmacology

Background:

  • Fingolimod is an oral disease-modifying therapy for multiple sclerosis (MS) that reduces lymphocyte trafficking to the central nervous system (CNS).
  • Initial Phase III trials reported infection rates comparable to placebo groups.
  • Post-marketing data have indicated an increased risk of opportunistic infections with fingolimod use.

Observation:

  • A case of cryptococcal meningoencephalitis and immune reconstitution inflammatory syndrome (IRIS) is presented in a patient treated with fingolimod.
  • The infection and IRIS occurred after the discontinuation of fingolimod therapy.

Findings:

  • Fingolimod-associated cryptococcosis can manifest even after drug cessation.
  • IRIS can complicate the course of opportunistic infections in patients previously treated with immunomodulatory drugs like fingolimod.

Implications:

  • Enhanced surveillance for opportunistic infections, particularly cryptococcosis, is crucial in patients treated with fingolimod.
  • Risk mitigation strategies should be developed to manage potential infections and IRIS following fingolimod discontinuation.
  • This case underscores the importance of considering delayed adverse effects of immunosuppressive therapies in MS management.
Keywords:
Cryptococcal meningoencephalitisFingolimodImmune reconstitution inflammatory syndromeMultiple sclerosis

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