title: Cryptococcal meningitis after fingolimod discontinuation in a patient with multiple sclerosis.
abstract: Fingolimod (Gilenya, Novartis) is an oral sphingosine-1-phosphate analogue used in the treatment of relapsing multiple sclerosis (MS). Fingolimod treatment is associated with relative lymphopenia and was associated with an increased risk of herpes infection in clinical trials. In the post-marketing setting, fingolimod has been associated with several cases of cryptococcal meningitis, recently prompting an update to its prescribing information. To date, all cases have been associated with active treatment with fingolimod. In this report, we describe the first case of cryptococcal meningitis diagnosed after fingolimod discontinuation.
authors.affiliation: Department of Neurology, University of Virginia, PO Box 800394, Charlottesville, VA 22908, USA. Electronic address: mdw8u@virginia.edu.
authors.forename: Melanie D
authors.initials: MD
authors.lastname: Ward
authors.affiliation: Department of Neurology, University of Virginia, PO Box 800394, Charlottesville, VA 22908, USA. Electronic address: dj9d@virginia.edu.
authors.forename: David E
authors.initials: DE
authors.lastname: Jones
authors.affiliation: Department of Neurology, University of Virginia, PO Box 800394, Charlottesville, VA 22908, USA. Electronic address: mdg3n@virginia.edu.
authors.forename: Myla D
authors.initials: MD
authors.lastname: Goldman
mesh_terms: D000368:Aged; D017809:Fatal Outcome; D005260:Female; D000068876:Fingolimod Hydrochloride / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016919:Meningitis, Cryptococcal / Q000150:complications* / Q000000981:diagnostic imaging; D008636:Mesencephalon / Q000000981:diagnostic imaging; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy*
chemical_list: D007166:Immunosuppressive Agents; D000068876:Fingolimod Hydrochloride
keywords: Cryptococcus; Fingolimod; Lymphopenia; Multiple sclerosis