Cutaneous cryptococcosis in a patient taking fingolimod for multiple sclerosis: Here come the opportunistic infections?
BACKGROUND
Fingolimod is an oral disease-modifying therapy for relapsing forms of multiple sclerosis, which acts by sequestering lymphocytes within lymph nodes.


OBJECTIVE
To describe a case of extrapulmonary cryptococcosis in a patient taking fingolimod.


METHODS
Case report.


RESULTS
A 47-year-old man developed a non-healing skin lesion approximately 16 months after starting treatment with fingolimod. Biopsy revealed cryptococcosis. Fingolimod was discontinued and the lesion resolved with antifungal therapy.


CONCLUSIONS
Despite few reported opportunistic infections in the pivotal clinical trials and first few years post-marketing, there has been a recent increase in reported AIDS-defining illnesses in patients taking fingolimod. Neurologists should be alert for opportunistic infections in their patients using this medication.
Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, USA/Brain Sciences Center, VA Medical Center, Minneapolis, MN, USA.
Adam F
AF
Carpenter
Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, USA/Brain Sciences Center, VA Medical Center, Minneapolis, MN, USA.
Shikha J
SJ
Goodwin
St. Paul Infectious Disease Associates, Ltd., St. Paul, MN, USA/Allina Health, St. Paul, MN, USA.
Peter F
PF
Bornstein
Twin Cities Dermatopathology, Plymouth, MN, USA.
Andrew J
AJ
Larson
St Croix Dermatology, Stillwater, MN, USA.
Christine K
CK
Markus
D000328:Adult; D003453:Cryptococcosis / Q000175:diagnosis / Q000188:drug therapy*; D000068876:Fingolimod Hydrochloride / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy*; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy*; D012008:Recurrence
D007166:Immunosuppressive Agents; D000068876:Fingolimod Hydrochloride
AIDS; Cryptococcosis; cutaneous; fingolimod; multiple sclerosis; skin