Hidden relationship between fingolimod and bleeding: Possible novel management of fingolimod-associated lymphopenia

Hanazono, Akira; Sanpei, Yui; Kamada, Shinji; Sugawara, Masashiro; Iijima, Katsunori

doi:10.1016/j.mehy.2020.109635

Cited by 2 publications

(1 citation statement)

References 16 publications

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“…The effect of fingolimod on lymphocyte counts appears to be reversible but may take several months after holding the drug ( 39 ). As red blood cells (RBC) are the main regulators of serum sphingosine-1 phosphate concentration, a decrease in the number of RBCs may affect the severity of fingolimod-associated lymphopenia and reversal of counts ( 40 ).…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal chest wall mass and rib osteomyelitis associated with the use of fingolimod: A case report and literature review

Carpenter

Etemady-Deylamy²,

Costello³

et al. 2022

Front. Med.

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Being introduced in 2010, fingolimod was among the first oral therapies for relapsing multiple sclerosis (MS). Since that time, postmarketing surveillance has noted several case reports of various cryptococcal infections associated with fingolimod use. To date, approximately 15 such case reports have been published. We present the first and unique case of cryptococcal chest wall mass and rib osteomyelitis associated with fingolimod use. The patient presented with left-side chest pain and was found to have a lower left chest wall mass. Computerized tomography (CT) showed chest wall mass with the destruction of left 7th rib. Aspirate from the mass grew Cryptococcus neoformans. The isolate was serotype A. Fingolimod was stopped. The patient received liposomal amphotericin B for 2 weeks and started on fluconazole with a plan to continue for 6–12 months. The follow-up CT in 6 weeks showed a marked decrease in the size of the chest wall mass. In conclusion, our case highlights the atypical and aggressive form of cryptococcal infection possibly related to immunosuppression from fingolimod use.

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Section: Discussionmentioning

confidence: 99%