PDF(Pubmed)
Abstract：
Fingolimod is a sphingosine-1-phosphate receptor modulator used to treat multiple sclerosis. While fingolimod has been associated with an increased risk of cryptococcal meningitis, its correlation with other deep mycoses remains unclear. In this study, we conducted a scoping review of fingolimod associated with histoplasmosis, based on a case report, a literature review, and data from the FDA Adverse Events Reporting System (FAERS) as of January 24th, 2023. A 30-year-old Brazilian woman diagnosed with relapsing-remitting multiple sclerosis, receiving a daily dose of 0.5 mg of fingolimod, presented with a two-month history of fever and unintended weight loss, accompanied by lymphadenopathy, splenomegaly, and lung involvement was investigated. Biopsy of a lung nodule revealed fungal structures suggestive of Histoplasma sp. Additionally, serological testing yielded positive for Histoplasma capsulatum. Disseminated histoplasmosis should be considered in the differential diagnosis of febrile syndromes in patients undergoing fingolimod therapy for multiple sclerosis, particularly in the Americas, where this mycosis is endemic. Treatment with itraconazole and modification of immunotherapy can achieve excellent clinical outcomes.
摘要：
芬戈莫德是一种鞘氨醇-1-磷酸受体调节剂，用于治疗多发性硬化症。虽然芬戈莫德与隐球菌性脑膜炎的风险增加有关，其与其他深部真菌病的相关性尚不清楚.在这项研究中,我们对与组织胞浆菌病相关的芬戈莫德进行了范围审查，根据病例报告,文献综述，以及FDA不良事件报告系统（FAERS）截至1月24日的数据，2023年。一名30岁的巴西妇女被诊断患有复发缓解型多发性硬化症，每天服用0.5毫克芬戈莫德，有两个月的发烧和意外体重减轻的病史，伴有淋巴结病，脾肿大,并对肺部受累情况进行了调查。肺结节的活检显示真菌结构提示组织胞浆。此外,血清学检测对荚膜组织胞浆呈阳性。在接受芬戈莫德治疗的多发性硬化症患者的发热综合征的鉴别诊断中，应考虑播散性组织胞浆菌病。特别是在美洲，这种真菌病是地方性的。伊曲康唑治疗和免疫疗法的修饰可以取得良好的临床效果。
