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

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...

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Autores principales: Foerch, Christian, Friedauer, Lucie, Bauer, Boris, Wolf, Timo, Adam, Elisabeth H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Author(s). Published by Elsevier B.V. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202802/
https://www.ncbi.nlm.nih.gov/pubmed/32408155
http://dx.doi.org/10.1016/j.msard.2020.102180
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author Foerch, Christian
Friedauer, Lucie
Bauer, Boris
Wolf, Timo
Adam, Elisabeth H.
author_facet Foerch, Christian
Friedauer, Lucie
Bauer, Boris
Wolf, Timo
Adam, Elisabeth H.
author_sort Foerch, Christian
collection PubMed
description 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.
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spelling pubmed-72028022020-05-07 Severe COVID-19 infection in a patient with multiple sclerosis treated with fingolimod Foerch, Christian Friedauer, Lucie Bauer, Boris Wolf, Timo Adam, Elisabeth H. Mult Scler Relat Disord Case Report 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. The Author(s). Published by Elsevier B.V. 2020-07 2020-05-06 /pmc/articles/PMC7202802/ /pubmed/32408155 http://dx.doi.org/10.1016/j.msard.2020.102180 Text en © 2020 The Author(s) Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Case Report
Foerch, Christian
Friedauer, Lucie
Bauer, Boris
Wolf, Timo
Adam, Elisabeth H.
Severe COVID-19 infection in a patient with multiple sclerosis treated with fingolimod
title Severe COVID-19 infection in a patient with multiple sclerosis treated with fingolimod
title_full Severe COVID-19 infection in a patient with multiple sclerosis treated with fingolimod
title_fullStr Severe COVID-19 infection in a patient with multiple sclerosis treated with fingolimod
title_full_unstemmed Severe COVID-19 infection in a patient with multiple sclerosis treated with fingolimod
title_short Severe COVID-19 infection in a patient with multiple sclerosis treated with fingolimod
title_sort severe covid-19 infection in a patient with multiple sclerosis treated with fingolimod
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202802/
https://www.ncbi.nlm.nih.gov/pubmed/32408155
http://dx.doi.org/10.1016/j.msard.2020.102180
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