ClinicSpeak: cryptococcal infection on fingolimod

A slow but steady number of opportunistic infections on fingolimod. #ClinicSpeak #MSBlog #MSResearch

"Another case of cryptococcal infection on fingolimod with only a moderate lymphopaenia. Cryptococcosis is an indolent fungal infection and is not typically associated with prominent systemic symptoms and signs (temperature, etc.). There are now an increasing number of localised and systemic case reports appearing of this complication. So if you are on fingolimod please be vigilant of any suspicious skin lesions and any other symptoms to suggest an infection. The one to watch out for is meningitis. So please take any recent onset headache, visual blurring and unexplained vomiting seriously. Unlike other DMTs that cause lymphopaenia you can't derisk fingolimod based on the lymphocyte count."

Epub: Forrestel et al. Primary Cutaneous Cryptococcus in a Patient With Multiple Sclerosis Treated With Fingolimod.JAMA Neurol. 2016 Jan 11:1-2. doi: 10.1001/jamaneurol.2015.4259.

A 62-year-old woman with multiple sclerosis treated with fingolimod for 3 years presented to clinic with a tender nodule on the forehead that was diagnosed by a tissue culture as Cryptococcus neoformans. The patient was diagnosed with primary cutaneous cryptococcosis. She presented to the clinic with a tender nodule on her forehead, which had gradually grown over 3 weeks (Figure). She reported bumping her forehead on an air-conditioning unit several months prior. She denied fever, neck stiffness, and photophobia, and her neurological examination was at her baseline. She lived alone with a pet cat and spent minimal time outdoors. Her lymphocyte count was 650/mm3 with an absolute CD4 count of 56/mm3 and CD8 count of 121/mm3.



CoI: multiple

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