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Cryptococcal Meningoencephalitis in a Patient With Multiple Sclerosis Treated With Fingolimod

Lutz Achtnichts, MD1; Otilia Obreja, MD, PhD1; Anna Conen, MD2; Christoph A. Fux, MD2; Krassen Nedeltchev, MD1
[+] Author Affiliations
1Department of Neurology, Cantonal Hospital of Aarau, Aarau, Switzerland
2Department of Infectious Diseases, Cantonal Hospital of Aarau, Aarau, Switzerland
JAMA Neurol. 2015;72(10):1203-1205. doi:10.1001/jamaneurol.2015.1746.
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This case report discusses a man with relapsing-remitting multiple sclerosis taking fingolimod who presented with throbbing bilateral, retro-orbital and temporal headache, photophobia, and lethargy.

Fingolimod, the first oral drug approved for relapsing-remitting multiple sclerosis (MS), acts primarily by blocking the outlet of lymphocytes from the lymph nodes.1 Despite the resulting lymphocytopenia, the overall incidences of infections with fingolimod were similar to those in the control groups of the pivotal studies.2 Nevertheless, since the drug’s approval in 2010, few cases of serious infections have emerged under fingolimod treatment.3

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Figure.
Magnetic Resonance Imaging (MRI) Findings on Repeated Examinations

A, On day 2, axial T2-weighted MRI shows multiple nonenhancing supratentorial and infratentorial (not shown) lesions (arrowheads). B, On day 8, new T2-weighted MRI lesions in the basal ganglia, again without gadolinium enhancement (arrowheads). Similar lesions were also identified in the pons and the mesencephalon (not shown). C, On day 28, gadolinium enhancement in the basal ganglia on T1-weighted MRI (arrowheads).

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