title: Disseminated Cryptococcosis in a 63-year-old Patient with Multiple Sclerosis Treated with Fingolimod.
abstract: We herein report the case of a 63-year-old man who presented with a 3-month history of a cutaneous nodular lesion of his jaw, low grade fever, lethargy and progressive cognitive impairment. He had a 30-year history of multiple sclerosis and had been treated with fingolimod for the previous 2 years. Laboratory data revealed CD4 lymphocytopenia and a tissue culture of the skin nodule was positive for Cryptococcus neoformans. Cerebrospinal fluid and serum cryptococcal antigen tests were also positive and we diagnosed him to have disseminated cryptococcosis. This dissemination might be associated with fingolimod-induced CD4 lymphocytopenia. The risk of an opportunistic infection should therefore be considered when encountering fingolimod-treated patients.
authors.affiliation: Department of General Internal Medicine, Kobe University Hospital, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Seto
authors.forename: Mitsushige
authors.initials: M
authors.lastname: Nishimura
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Minamiji
authors.forename: Sonoko
authors.initials: S
authors.lastname: Miyoshi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Mori
authors.forename: Kenji
authors.initials: K
authors.lastname: Kanazawa
authors.forename: Hisafumi
authors.initials: H
authors.lastname: Yasuda
mesh_terms: D000368:Aged; D003453:Cryptococcosis / Q000175:diagnosis* / Q000209:etiology*; D003455:Cryptococcus neoformans; D000068876:Fingolimod Hydrochloride / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications* / Q000188:drug therapy
chemical_list: D007166:Immunosuppressive Agents; D000068876:Fingolimod Hydrochloride