title: Herpes zoster laryngitis in a patient treated with fingolimod.
abstract: Development of treatment with immunomodulatory agents has improved prognosis of various autoimmune-related diseases. A sphingosin-1-phosphate receptor modulator, or fingolimod, is the first licensed oral drug for relapsing-remitting multiple sclerosis. The agent reduces circulating lymphocytes by trapping T cells in lymph nodes, possibly leading to reactivation of latent viruses. A 41-year-old Japanese woman who had been treated with fingolimod for 2 years presented with unilateral sore throat. Laryngoscopy revealed exudates unilaterally emerging on the left side of her supraglottic region. Serum level of the varicella zoster virus (VZV)-specific IgG was markedly elevated, and a result of genome sequence using the exudates demonstrated VZV as a possible causative pathogen. Fingolimod therapy was discontinued and the patient was successfully treated with intravenous acyclovir. This is the first reported case of fingolimod-associated herpes zoster laryngitis, in which the local VZV reactivation was demonstrated by next-generation sequencing technology. The present case highlights that the occurrence of VZV reactivation should be recalled in any patients undergoing fingolimod therapy.
authors.affiliation: Division of Infection Control and Prevention, Osaka University Hospital, Japan. Electronic address: highgear@hp-infect.med.osaka-u.ac.jp.
authors.forename: Hideharu
authors.initials: H
authors.lastname: Hagiya
authors.affiliation: Division of Infection Control and Prevention, Osaka University Hospital, Japan. Electronic address: falco60v@yahoo.co.jp.
authors.forename: Hisao
authors.initials: H
authors.lastname: Yoshida
authors.affiliation: Department of Neurology, Osaka University Hospital, Japan. Electronic address: u168970j@ecs.osaka-u.ac.jp.
authors.forename: Mikito
authors.initials: M
authors.lastname: Shimizu
authors.affiliation: Department of Infection Metagenomics, Research Institute for Microbial Disease, Osaka University, Japan. Electronic address: daisukem@gen-info.osaka-u.ac.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Motooka
authors.affiliation: Department of Infection Metagenomics, Research Institute for Microbial Disease, Osaka University, Japan. Electronic address: nshota@gen-info.osaka-u.ac.jp.
authors.forename: Shota
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Infection Metagenomics, Research Institute for Microbial Disease, Osaka University, Japan; Department of Bacterial Infections, Research Institute for Microbial Diseases, Osaka University, Japan. Electronic address: iida@biken.osaka-u.ac.jp.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Iida
authors.affiliation: Division of Infection Control and Prevention, Osaka University Hospital, Japan. Electronic address: norihisa65@hp-infect.med.osaka-u.ac.jp.
authors.forename: Norihisa
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Division of Infection Control and Prevention, Osaka University Hospital, Japan. Electronic address: akeda@biken.osaka-u.ac.jp.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Akeda
authors.affiliation: Division of Infection Control and Prevention, Osaka University Hospital, Japan. Electronic address: tomono@hp-infect.med.osaka-u.ac.jp.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Tomono
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D005260:Female; D000068876:Fingolimod Hydrochloride / Q000009:adverse effects*; D006562:Herpes Zoster / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000821:virology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007827:Laryngitis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000821:virology; D014775:Virus Activation / Q000187:drug effects
chemical_list: D007166:Immunosuppressive Agents; D000068876:Fingolimod Hydrochloride; D000212:Acyclovir
keywords: Fingolimod; Herpes zoster virus; Laryngopharyngitis; Metagenomic analysis; Next-generation sequencing technology