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Fingolimod-associated cryptococcal meningitis in a patient with Multiple Sclerosis: A case report and literature

Hidenori Nakagawa1, Akari Takagi2, Takahiro Mitsueda2

  • 1Department of Infectious Diseases, Osaka City General Hospital, Osaka, Japan.

Idcases
|January 29, 2025
PubMed

Insights

Fingolimod treatment for Multiple Sclerosis can lead to cryptococcal meningitis, a serious infection. Early symptoms include headaches, and diagnosis relies on detecting Cryptococcus neoformans antigens in cerebrospinal fluid.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Immunology

Background:

  • Multiple Sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
  • Fingolimod is an immunomodulatory drug used to treat relapsing forms of MS.
  • Immunosuppression increases the risk of opportunistic infections, including fungal meningitis.

Observation:

  • A 65-year-old woman with MS on fingolimod presented with headaches and convulsions.
  • Cerebrospinal fluid (CSF) analysis revealed Cryptococcus neoformans.
  • A literature review identified 20 similar cases of cryptococcal meningitis.

Findings:

  • Headache was the most frequent initial symptom in cryptococcal meningitis cases.
  • All reviewed cases tested positive for serum and/or CSF Cryptococcus neoformans antigens.
  • Fingolimod-treated patients may be at increased risk for this opportunistic infection.

Implications:

  • Clinicians should consider cryptococcal meningitis in MS patients on fingolimod presenting with neurological symptoms.
  • Prompt diagnosis via antigen testing is crucial for effective treatment.
  • Monitoring for opportunistic infections is essential in patients receiving immunosuppressive therapies for MS.
Keywords:
Cryptococcus neoformansFingolimodMeningitisMultiple Sclerosis

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