The binding of the S1P receptor on T lymphocytes blocks their migration from the lymph nodes to the CNS. It was indicated as a DMT for the treatment of adult patients and pediatric patients of 10 years of age and above with RRMS to reduce the frequency of relapses and to delay the progression of disability. Fingolimod, a first-in-class Sphingosine-1-Phosphate (S1P) receptor modulator was the first oral drug to be approved for the treatment of MS. As the number of treatment-related infections is increasing, careful diagnosis of MS patients presenting with new neurological symptoms is essential. Most drugs used in MS treatment are linked to an increased risk of infection to varying degrees, depending on their mechanism of action. Currently approved Disease-Modifying Therapies (DMTs) are immunomodulatory or immunosuppressive drugs that significantly, although variably, reduce the frequency of attacks of the relapsing forms of the disease. This chronic inflammatory condition of the CNS is caused by an autoimmune process, leading to multifocal demyelination and axonal loss, mostly in the white matter, but importantly also in the grey matter of both brain and spinal cord. Multiple Sclerosis (MS), the most common neurological disability, is an autoimmune disorder that affects the Central Nervous System (CNS) and often leads to severe physical or cognitive dysfunctions in young adults. Keywords: Fingolimod Cryptococcal meningitis Multiple sclerosis Disease-modifying therapiesĪbbreviations: MS: Multiple Sclerosis CNS: Central Nervous System DMTS: Disease-Modifying Therapies S1P: Sphingosine-1-Phosphate RRMS: Relapsing-Remitting MS PML: Progressive Multifocal Leukoencephalopathy HSV: Herpes Simplex Virus CSF: Cerebrospinal Fluid MRI: Magnetic Resonance Imaging MRC: Medical Research Council CRP: C-Reactive Protein INF: Interferon AIDS: Acquired Immunodeficiency Syndrome IRIS: Immune Reconstitution Inflammatory Responses In this report, we present the treatment problems that arise in patients with MS treated with immunomodulation therapy who develop an opportunistic infection. Recommendations for the surveillance of opportunistic infections are increasingly needed as more patients are treated with immunomodulation therapy for longer durations and at older ages. Conclusion: Some agents carry a risk of opportunistic and life-threatening infections. In the control examination, CSF culture showed no microbial growth and MRI showed an improvement in the radiological condition. The patient's general and neurological condition gradually improved. Amphotericin B with fluconazole were included and fingolimod was discontinued. ![]() Cryptococcal meningitis has been recognized. Finally, a culture of the CSF showed Cryptococcus neoformans growth. In Magnetic Resonance Imaging (MRI) strengthening of the meninges of the brain and cerebellum was visualized. Examination of Cerebrospinal Fluid (CSF) showed intensified cytosis, increased protein level and decreased glucose level. The results of laboratory and imaging tests were inconclusive. She has been treated with fingolimod science 2013. She was reported to the hospital emergency department due to headache with accompanying low-grade fever. Case presentation: We present a 46-year old woman with RRMS on fingolimod therapy with a rare case of cryptococcal meningitis. Early diagnosis and appropriate treatment are essential to improve prognosis and reduce mortality in these cases. Post-marketing experience has documented several cases of cryptococcal meningitis and disseminated cryptococcosis. ![]() ![]() However, fingolimod may be associated with a higher risk of several different opportunistic infections, including cryptococcosis. Integrated analysis of the long-term safety studies results showed that there was no overall increase in the risk of infection in patients treated with fingolimod compared to patients treated with placebo. Background: Fingolimod is an oral medication approved by the Food and Drug Administration for the treatment of Relapsing Remitting Multiple Sclerosis (RRMS).
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