Severe COVID-19 infection in a patient with multiple sclerosis treated with fingolimod
Non-conventional
| WHO COVID | ID: covidwho-186328
ABSTRACT
Background:
Fingolimod is used for immune therapy in patients with multiple sclerosis. Long-term treatment is associated with a small increase in the risk of herpes virus reactivation and respiratory tract infections. Patients with coronavirus disease 2019 (COVID-19) under Fingolimod treatment have not been described. Methods andresults:
We report a 57-year old female patient with a relapsing remitting multiple sclerosis under fingolimod treatment who experienced a severe COVID-19 infection in March 2020 (Extended Disability Status Scale 2.0). Having peripheral lymphopenia typical for fingolimod treatment (total lymphocytes 0.39/nL [1.22-3.56]), the patient developed bilateral interstitial pneumonia with multiple ground-glass opacities on chest CT. Fingolimod medication was stopped. On the intensive care unit, non-invasive ventilation was used to provide oxygen and ventilation support regularly. Over the following two days, oxygenation improved, and the patient was transferred to a normal ward five days after admission.Conclusion:
The implications fingolimod has on COVID-19 are complex. As an S1P analogue, fingolimod might enhance lung endothelial cell integrity. In addition, in case of a so-called cytokine storm, immunomodulation might be beneficial to reduce mortality. Future studies are needed to explore the risks and therapeutic effects of fingolimod in COVID-19 patients.
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Collection:
Databases of international organizations
Database:
WHO COVID
Type of study:
Prognostic study
Document Type:
Non-conventional
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