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Review
. 2020 Mar 30;20(1):257.
doi: 10.1186/s12879-020-04988-7.

Cryptosporidiosis after treatment with fingolimod: a case report and pharmacovigilance review

M Martinot  1 , A Abou-Bacar  2 , M Lamothe  3 , M Alt Tebacher  3 , M Mohseni Zadeh  4 , F Dalle  5 , L Favennec  6   7 , D Costa  6   7 , J Brunet  2   8 , F Sellal  9
Affiliations
Review

Cryptosporidiosis after treatment with fingolimod: a case report and pharmacovigilance review

M Martinot et al. BMC Infect Dis. .

Abstract

Background: Cryptosporidium sp. are common intracellular parasites responsible of severe diarrhea in T-cell-immunocompromised patients. We report the first case of a woman who contracted cryptosporidiosis after treatment with fingolimod, a drug labeled for multiple sclerosis and responsible for marked lymphopenia.

Case presentation: A 60-year-old woman was admitted for abdominal pain diarrhea and fever. The patient suffered from multiple sclerosis and had been treated with fingolimod from august 2017 to september 2018 time of occurrence of the first digestive symptoms. Stool culture was negative but parasitological examination was positive for Cryptosporidium sp. Blood biological examination profound lymphopenia of 240/mm3 [17 CD4/mm3 (7%) and 32 CD8/mm3 (14%)]. Fingolimod was stopped, and the patient was put on nitazoxanide 500 mg bid for 7 days. The diarrhea resolved and no relapse was observed. Six other cases were found in the Pharmacovigilance database.

Conclusion: Physicians should be aware of this association and screen for Cryptosporidium in cases of diarrhea in patients treated with fingolimod. Patients should be aware of this risk and advise to take appropriate measures to avoid such contamination.

Keywords: Cryptosporidiosis; Cryptosporidium; Fingolimod; Multiple sclerosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Cryptosporidium oocysts from stool, stained with modified Ziehl–Neelsen acid-fast stain. 54x40mm (220 × 220 DPI)
See this image and copyright information in PMC

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