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Case Reports
. 2022 Sep 7:9:942751.
doi: 10.3389/fmed.2022.942751. eCollection 2022.

Cryptococcal chest wall mass and rib osteomyelitis associated with the use of fingolimod: A case report and literature review

Kent Carpenter  1 , Ali Etemady-Deylamy  1 , Victoria Costello  1 , Mohammad Khasawneh  1 , Robin Chamberland  2   3 , Katherine Tian  1 , Maureen Donlin  4 , Brenda Moreira-Walsh  4 , Emily Reisenbichler  3 , Getahun Abate  1
Affiliations
Case Reports

Cryptococcal chest wall mass and rib osteomyelitis associated with the use of fingolimod: A case report and literature review

Kent Carpenter et al. Front Med (Lausanne). .

Abstract

Being introduced in 2010, fingolimod was among the first oral therapies for relapsing multiple sclerosis (MS). Since that time, postmarketing surveillance has noted several case reports of various cryptococcal infections associated with fingolimod use. To date, approximately 15 such case reports have been published. We present the first and unique case of cryptococcal chest wall mass and rib osteomyelitis associated with fingolimod use. The patient presented with left-side chest pain and was found to have a lower left chest wall mass. Computerized tomography (CT) showed chest wall mass with the destruction of left 7th rib. Aspirate from the mass grew Cryptococcus neoformans. The isolate was serotype A. Fingolimod was stopped. The patient received liposomal amphotericin B for 2 weeks and started on fluconazole with a plan to continue for 6-12 months. The follow-up CT in 6 weeks showed a marked decrease in the size of the chest wall mass. In conclusion, our case highlights the atypical and aggressive form of cryptococcal infection possibly related to immunosuppression from fingolimod use.

Keywords: chest mass; cryptococcus; fingolimod; immunosuppression; osteomyelitis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Timeline of progression of illness and workup.
Figure 2
Figure 2
Imaging findings of chest wall mass and rib osteomyelitis. (A) Chest X-ray shows destruction of a rib. (B) Left chest wall mass (axial image). (C) Left chest wall mass (coronal view). Green arrow indicates the level of 7th rib fracture and mass.
Figure 3
Figure 3
Grocott's Methenamine Silver (GMS) stain of aspirate showing yeast forms. Objective: 200×.
See this image and copyright information in PMC

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