title: Epstein Barr virus infection reactivation as a possible trigger of primary biliary cirrhosis-like syndrome in a patient with multiple sclerosis in the course of fingolimod treatment.
abstract: Primary biliary cirrhosis (PBC) and multiple sclerosis (MS) are considered autoimmune diseases with a multifactorial aetiology which is thought to be due to a combination of genetic predisposition and environmental triggers. An association of both diseases has been previously described in sporadic case reports. Fingolimod, an antagonist of the sphingosine 1 phosphate receptor family (S1P1/3/4/5), is a promising and effective drug in the treatment of MS. Here we describe a case of PBC like syndrome that was unmasked, concomitantly or consequently to Epstein Barr virus (EBV) infection reactivation, in a 34 year old male patient with relapsing remitting multiple sclerosis who was receiving fingolimod treatment.
authors.affiliation: Internal Medicine and Hepatology, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences; Department of Clinical and Experimental Medicine and Surgery F. Magrassi and A. Lanzara; Department of Biochemistry, Biophysics and General Pathology, Second University of Naples (SUN); Internal Medicine of Clinic Hospital of Marcianise, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Caserta, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Marrone
authors.affiliation: Internal Medicine and Hepatology, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences; Department of Clinical and Experimental Medicine and Surgery F. Magrassi e A. Lanzara; Department of Biochemistry, Biophysics and General Pathology, Second University of Naples (SUN); Internal Medicine of Clinic Hospital of Marcianise, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Caserta, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Signoriello
authors.affiliation: Internal Medicine and Hepatology, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences; Department of Clinical and Experimental Medicine and Surgery F. Magrassi e A. Lanzara; Department of Biochemistry, Biophysics and General Pathology, Second University of Naples (SUN); Internal Medicine of Clinic Hospital of Marcianise, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Caserta, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Alfieri
authors.affiliation: Internal Medicine and Hepatology, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences; Department of Clinical and Experimental Medicine and Surgery F. Magrassi e A. Lanzara; Department of Biochemistry, Biophysics and General Pathology, Second University of Naples (SUN); Internal Medicine of Clinic Hospital of Marcianise, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Caserta, Italy.
authors.forename: Liliana
authors.initials: L
authors.lastname: Dalla Mora
authors.affiliation: Internal Medicine and Hepatology, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences; Department of Clinical and Experimental Medicine and Surgery F. Magrassi e A. Lanzara; Department of Biochemistry, Biophysics and General Pathology, Second University of Naples (SUN); Internal Medicine of Clinic Hospital of Marcianise, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Caserta, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Rinaldi
authors.affiliation: Internal Medicine and Hepatology, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences; Department of Clinical and Experimental Medicine and Surgery F. Magrassi e A. Lanzara; Department of Biochemistry, Biophysics and General Pathology, Second University of Naples (SUN); Internal Medicine of Clinic Hospital of Marcianise, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Caserta, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Rainone
authors.affiliation: Internal Medicine and Hepatology, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences; Department of Clinical and Experimental Medicine and Surgery F. Magrassi e A. Lanzara; Department of Biochemistry, Biophysics and General Pathology, Second University of Naples (SUN); Internal Medicine of Clinic Hospital of Marcianise, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Caserta, Italy.
authors.forename: Luigi Elio
authors.initials: LE
authors.lastname: Adinolfi
authors.affiliation: Internal Medicine and Hepatology, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences; Department of Clinical and Experimental Medicine and Surgery F. Magrassi e A. Lanzara; Department of Biochemistry, Biophysics and General Pathology, Second University of Naples (SUN); Internal Medicine of Clinic Hospital of Marcianise, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Caserta, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Lus
mesh_terms: D000328:Adult; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D000068876:Fingolimod Hydrochloride / Q000008:administration & dosage / Q000009:adverse effects*; D004854:Herpesvirus 4, Human / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008105:Liver Cirrhosis, Biliary / Q000150:complications* / Q000188:drug therapy; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications* / Q000188:drug therapy*; D012008:Recurrence; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use; D028761:Withholding Treatment
chemical_list: D002756:Cholagogues and Choleretics; D007166:Immunosuppressive Agents; D014580:Ursodeoxycholic Acid; D000068876:Fingolimod Hydrochloride