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Case Reports
. 2020 Jul:42:102180.
doi: 10.1016/j.msard.2020.102180. Epub 2020 May 6.

Severe COVID-19 infection in a patient with multiple sclerosis treated with fingolimod

Christian Foerch  1 , Lucie Friedauer  2 , Boris Bauer  3 , Timo Wolf  4 , Elisabeth H Adam  5
Affiliations
Case Reports

Severe COVID-19 infection in a patient with multiple sclerosis treated with fingolimod

Christian Foerch et al. Mult Scler Relat Disord. 2020 Jul.

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 and results: 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 [reference range 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.

Keywords: COVID-19; Critical care; Fingolimod; Multiple sclerosis; Viral infection.

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Conflict of interest statement

Declaration of Competing Interest CF reports speaker honoraria and honoraria for participating in advisory boards from Novartis, Teva, Merck, Sanofi-Genzyme, and Roche. CF received research support from Sanofi-Genzyme LF has no conflicts of interest to disclose BB has no conflicts of interest to disclose TW has no conflicts of interest to disclose EA has no conflicts of interest to disclose No funding was received for this study.

Figures

Fig 1
Fig. 1
Chest CT images. Chest CT imaging showed bilateral, multiple ground-glass opacities with a peripheral lung and subpleural distribution in the upper and lower lobes.
See this image and copyright information in PMC

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