TY  - JOUR
A1  - Förch, Christian
A1  - Friedauer, Lucie
A1  - Bauer, Boris
A1  - Wolf, Timo
A1  - Adam, Elisabeth
T1  - Severe COVID-19 infection in a patient with multiple sclerosis treated with fingolimod
T2  - Multiple sclerosis and related disorders
N2  - 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.
KW  - Critical care
KW  - Multiple sclerosis
KW  - Fingolimod
KW  - Viral infection
KW  - COVID-19
Y1  - 2020
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/54735
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-547357
SN  - 2211-0348
VL  - 42
IS  - 102180
PB  - Elsevier
CY  - Amsterdam [u.a.]
ER  -