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Related Experiment Video

Updated: Jul 14, 2025

Author Spotlight: Creating a Versatile Experimental Autoimmune Encephalomyelitis Model Relevant for Both Male and Female Mice
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Cryptococcal meningoencephalitis in multiple sclerosis treated with fingolimod.

Moneeb Nasir1, Ian Galea2,3, Aidan Neligan4,5

  • 1The Royal London Hospital, Barts Health NHS Trust, London, UK moneeb.nasir@nhs.net.

Practical Neurology
|October 6, 2023
PubMed
Summary

A multiple sclerosis patient on fingolimod presented with severe headache mimicking subarachnoid hemorrhage. Early diagnosis of cryptococcal meningoencephalitis was crucial for timely treatment in this immunosuppressed individual.

Keywords:
INFECTIOUS DISEASESMICROBIOLOGYSUBARACHNOID HAEMORRHAGE

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Area of Science:

  • Neuroimmunology
  • Infectious Diseases
  • Neurology

Background:

  • Multiple sclerosis (MS) management often involves immunosuppressive therapies like fingolimod.
  • Immunosuppression increases the risk of opportunistic infections, including central nervous system (CNS) infections.

Observation:

  • A 21-year-old woman with MS on fingolimod experienced sudden severe headache, nausea, and malaise.
  • Initial neurological exam, CT head, and venogram were unremarkable. Lymphocyte count was low (0.53 x 10^9/L).

Findings:

  • Cerebrospinal fluid (CSF) analysis revealed elevated opening pressure (33 cm H2O) and incidental growth of *Cryptococcus neoformans*.
  • Diagnosis was confirmed by India Ink stain and positive cryptococcal antigen, indicating cryptococcal meningoencephalitis.

Implications:

  • This case underscores the importance of considering opportunistic CNS infections in immunosuppressed patients presenting with atypical neurological symptoms.
  • The presentation mimicked subarachnoid hemorrhage, highlighting the need for vigilance and thorough diagnostic workup in patients on disease-modifying therapies for MS.