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May 2022; 9 (3) Research ArticleOpen Access

Cryptococcal Meningitis Reported With Fingolimod Treatment

Case Series

View ORCID ProfileMaurizio Del Poeta, Brian J. Ward, Benjamin Greenberg, View ORCID ProfileBernhard Hemmer, Bruce A.C. Cree, Sreelatha Komatireddy, Jitendriya Mishra, View ORCID ProfileRoseanne Sullivan, Ajay Kilaru, Alan Moore, View ORCID ProfileThomas Hach, Joseph R. Berger
First published March 22, 2022, DOI: https://doi.org/10.1212/NXI.0000000000001156
Maurizio Del Poeta
From the Department of Microbiology and Immunology (M.D.P.), Stony Brook University; Division of Infectious Diseases (M.D.P.), School of Medicine, Stony Brook University; Veterans Affairs Medical Center (M.D.P.), Northport, NY; Infectious Diseases Division (B.J.W.), Research Institute of the McGill University Health Centre, Montreal, QC, Canada; University of Texas Southwestern Medical Center (B.G.), Department of Neurology, Dallas, TX; Department of Neurology (B.H.), Klinikum Rechts der Isar, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany; UCSF Weill Institute for Neurosciences (B.A.C.C.), Department of Neurology, University of California San Francisco; Novartis Healthcare Pvt. Ltd. (S.K., J.M.), Hyderabad, India; Novartis Pharmaceuticals Corporation (R.S.), East Hanover, NJ; Novartis Pharma AG (A.K., A.M., T.H.), Basel, Switzerland; and Department of Neurology (J.R.B.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
MD
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  • ORCID record for Maurizio Del Poeta
  • For correspondence: maurizio.delpoeta@stonybrook.edu
Brian J. Ward
From the Department of Microbiology and Immunology (M.D.P.), Stony Brook University; Division of Infectious Diseases (M.D.P.), School of Medicine, Stony Brook University; Veterans Affairs Medical Center (M.D.P.), Northport, NY; Infectious Diseases Division (B.J.W.), Research Institute of the McGill University Health Centre, Montreal, QC, Canada; University of Texas Southwestern Medical Center (B.G.), Department of Neurology, Dallas, TX; Department of Neurology (B.H.), Klinikum Rechts der Isar, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany; UCSF Weill Institute for Neurosciences (B.A.C.C.), Department of Neurology, University of California San Francisco; Novartis Healthcare Pvt. Ltd. (S.K., J.M.), Hyderabad, India; Novartis Pharmaceuticals Corporation (R.S.), East Hanover, NJ; Novartis Pharma AG (A.K., A.M., T.H.), Basel, Switzerland; and Department of Neurology (J.R.B.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
MDCM
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  • For correspondence: brian.ward@mcgill.ca
Benjamin Greenberg
From the Department of Microbiology and Immunology (M.D.P.), Stony Brook University; Division of Infectious Diseases (M.D.P.), School of Medicine, Stony Brook University; Veterans Affairs Medical Center (M.D.P.), Northport, NY; Infectious Diseases Division (B.J.W.), Research Institute of the McGill University Health Centre, Montreal, QC, Canada; University of Texas Southwestern Medical Center (B.G.), Department of Neurology, Dallas, TX; Department of Neurology (B.H.), Klinikum Rechts der Isar, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany; UCSF Weill Institute for Neurosciences (B.A.C.C.), Department of Neurology, University of California San Francisco; Novartis Healthcare Pvt. Ltd. (S.K., J.M.), Hyderabad, India; Novartis Pharmaceuticals Corporation (R.S.), East Hanover, NJ; Novartis Pharma AG (A.K., A.M., T.H.), Basel, Switzerland; and Department of Neurology (J.R.B.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
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  • For correspondence: benjamin.greenberg@utsouthwestern.edu
Bernhard Hemmer
From the Department of Microbiology and Immunology (M.D.P.), Stony Brook University; Division of Infectious Diseases (M.D.P.), School of Medicine, Stony Brook University; Veterans Affairs Medical Center (M.D.P.), Northport, NY; Infectious Diseases Division (B.J.W.), Research Institute of the McGill University Health Centre, Montreal, QC, Canada; University of Texas Southwestern Medical Center (B.G.), Department of Neurology, Dallas, TX; Department of Neurology (B.H.), Klinikum Rechts der Isar, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany; UCSF Weill Institute for Neurosciences (B.A.C.C.), Department of Neurology, University of California San Francisco; Novartis Healthcare Pvt. Ltd. (S.K., J.M.), Hyderabad, India; Novartis Pharmaceuticals Corporation (R.S.), East Hanover, NJ; Novartis Pharma AG (A.K., A.M., T.H.), Basel, Switzerland; and Department of Neurology (J.R.B.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
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  • For correspondence: hemmer@tum.de
Bruce A.C. Cree
From the Department of Microbiology and Immunology (M.D.P.), Stony Brook University; Division of Infectious Diseases (M.D.P.), School of Medicine, Stony Brook University; Veterans Affairs Medical Center (M.D.P.), Northport, NY; Infectious Diseases Division (B.J.W.), Research Institute of the McGill University Health Centre, Montreal, QC, Canada; University of Texas Southwestern Medical Center (B.G.), Department of Neurology, Dallas, TX; Department of Neurology (B.H.), Klinikum Rechts der Isar, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany; UCSF Weill Institute for Neurosciences (B.A.C.C.), Department of Neurology, University of California San Francisco; Novartis Healthcare Pvt. Ltd. (S.K., J.M.), Hyderabad, India; Novartis Pharmaceuticals Corporation (R.S.), East Hanover, NJ; Novartis Pharma AG (A.K., A.M., T.H.), Basel, Switzerland; and Department of Neurology (J.R.B.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
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  • For correspondence: bruce.cree@ucsf.edu
Sreelatha Komatireddy
From the Department of Microbiology and Immunology (M.D.P.), Stony Brook University; Division of Infectious Diseases (M.D.P.), School of Medicine, Stony Brook University; Veterans Affairs Medical Center (M.D.P.), Northport, NY; Infectious Diseases Division (B.J.W.), Research Institute of the McGill University Health Centre, Montreal, QC, Canada; University of Texas Southwestern Medical Center (B.G.), Department of Neurology, Dallas, TX; Department of Neurology (B.H.), Klinikum Rechts der Isar, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany; UCSF Weill Institute for Neurosciences (B.A.C.C.), Department of Neurology, University of California San Francisco; Novartis Healthcare Pvt. Ltd. (S.K., J.M.), Hyderabad, India; Novartis Pharmaceuticals Corporation (R.S.), East Hanover, NJ; Novartis Pharma AG (A.K., A.M., T.H.), Basel, Switzerland; and Department of Neurology (J.R.B.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
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  • For correspondence: sreelatha.komatireddy@novartis.com
Jitendriya Mishra
From the Department of Microbiology and Immunology (M.D.P.), Stony Brook University; Division of Infectious Diseases (M.D.P.), School of Medicine, Stony Brook University; Veterans Affairs Medical Center (M.D.P.), Northport, NY; Infectious Diseases Division (B.J.W.), Research Institute of the McGill University Health Centre, Montreal, QC, Canada; University of Texas Southwestern Medical Center (B.G.), Department of Neurology, Dallas, TX; Department of Neurology (B.H.), Klinikum Rechts der Isar, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany; UCSF Weill Institute for Neurosciences (B.A.C.C.), Department of Neurology, University of California San Francisco; Novartis Healthcare Pvt. Ltd. (S.K., J.M.), Hyderabad, India; Novartis Pharmaceuticals Corporation (R.S.), East Hanover, NJ; Novartis Pharma AG (A.K., A.M., T.H.), Basel, Switzerland; and Department of Neurology (J.R.B.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
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  • For correspondence: jitendriya.mishra@novartis.com
Roseanne Sullivan
From the Department of Microbiology and Immunology (M.D.P.), Stony Brook University; Division of Infectious Diseases (M.D.P.), School of Medicine, Stony Brook University; Veterans Affairs Medical Center (M.D.P.), Northport, NY; Infectious Diseases Division (B.J.W.), Research Institute of the McGill University Health Centre, Montreal, QC, Canada; University of Texas Southwestern Medical Center (B.G.), Department of Neurology, Dallas, TX; Department of Neurology (B.H.), Klinikum Rechts der Isar, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany; UCSF Weill Institute for Neurosciences (B.A.C.C.), Department of Neurology, University of California San Francisco; Novartis Healthcare Pvt. Ltd. (S.K., J.M.), Hyderabad, India; Novartis Pharmaceuticals Corporation (R.S.), East Hanover, NJ; Novartis Pharma AG (A.K., A.M., T.H.), Basel, Switzerland; and Department of Neurology (J.R.B.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
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  • For correspondence: roseanne.sullivan@novartis.com
Ajay Kilaru
From the Department of Microbiology and Immunology (M.D.P.), Stony Brook University; Division of Infectious Diseases (M.D.P.), School of Medicine, Stony Brook University; Veterans Affairs Medical Center (M.D.P.), Northport, NY; Infectious Diseases Division (B.J.W.), Research Institute of the McGill University Health Centre, Montreal, QC, Canada; University of Texas Southwestern Medical Center (B.G.), Department of Neurology, Dallas, TX; Department of Neurology (B.H.), Klinikum Rechts der Isar, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany; UCSF Weill Institute for Neurosciences (B.A.C.C.), Department of Neurology, University of California San Francisco; Novartis Healthcare Pvt. Ltd. (S.K., J.M.), Hyderabad, India; Novartis Pharmaceuticals Corporation (R.S.), East Hanover, NJ; Novartis Pharma AG (A.K., A.M., T.H.), Basel, Switzerland; and Department of Neurology (J.R.B.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
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  • For correspondence: ajay.kilaru@novartis.com
Alan Moore
From the Department of Microbiology and Immunology (M.D.P.), Stony Brook University; Division of Infectious Diseases (M.D.P.), School of Medicine, Stony Brook University; Veterans Affairs Medical Center (M.D.P.), Northport, NY; Infectious Diseases Division (B.J.W.), Research Institute of the McGill University Health Centre, Montreal, QC, Canada; University of Texas Southwestern Medical Center (B.G.), Department of Neurology, Dallas, TX; Department of Neurology (B.H.), Klinikum Rechts der Isar, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany; UCSF Weill Institute for Neurosciences (B.A.C.C.), Department of Neurology, University of California San Francisco; Novartis Healthcare Pvt. Ltd. (S.K., J.M.), Hyderabad, India; Novartis Pharmaceuticals Corporation (R.S.), East Hanover, NJ; Novartis Pharma AG (A.K., A.M., T.H.), Basel, Switzerland; and Department of Neurology (J.R.B.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
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  • For correspondence: alan.moore@novartis.com
Thomas Hach
From the Department of Microbiology and Immunology (M.D.P.), Stony Brook University; Division of Infectious Diseases (M.D.P.), School of Medicine, Stony Brook University; Veterans Affairs Medical Center (M.D.P.), Northport, NY; Infectious Diseases Division (B.J.W.), Research Institute of the McGill University Health Centre, Montreal, QC, Canada; University of Texas Southwestern Medical Center (B.G.), Department of Neurology, Dallas, TX; Department of Neurology (B.H.), Klinikum Rechts der Isar, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany; UCSF Weill Institute for Neurosciences (B.A.C.C.), Department of Neurology, University of California San Francisco; Novartis Healthcare Pvt. Ltd. (S.K., J.M.), Hyderabad, India; Novartis Pharmaceuticals Corporation (R.S.), East Hanover, NJ; Novartis Pharma AG (A.K., A.M., T.H.), Basel, Switzerland; and Department of Neurology (J.R.B.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
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  • For correspondence: thomas.hach@novartis.com
Joseph R. Berger
From the Department of Microbiology and Immunology (M.D.P.), Stony Brook University; Division of Infectious Diseases (M.D.P.), School of Medicine, Stony Brook University; Veterans Affairs Medical Center (M.D.P.), Northport, NY; Infectious Diseases Division (B.J.W.), Research Institute of the McGill University Health Centre, Montreal, QC, Canada; University of Texas Southwestern Medical Center (B.G.), Department of Neurology, Dallas, TX; Department of Neurology (B.H.), Klinikum Rechts der Isar, Technical University of Munich; Munich Cluster for Systems Neurology (SyNergy) (B.H.), Germany; UCSF Weill Institute for Neurosciences (B.A.C.C.), Department of Neurology, University of California San Francisco; Novartis Healthcare Pvt. Ltd. (S.K., J.M.), Hyderabad, India; Novartis Pharmaceuticals Corporation (R.S.), East Hanover, NJ; Novartis Pharma AG (A.K., A.M., T.H.), Basel, Switzerland; and Department of Neurology (J.R.B.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
MD, FACP, FAAN, FANA
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Full PDF
Citation
Cryptococcal Meningitis Reported With Fingolimod Treatment
Case Series
Maurizio Del Poeta, Brian J. Ward, Benjamin Greenberg, Bernhard Hemmer, Bruce A.C. Cree, Sreelatha Komatireddy, Jitendriya Mishra, Roseanne Sullivan, Ajay Kilaru, Alan Moore, Thomas Hach, Joseph R. Berger
Neurol Neuroimmunol Neuroinflamm May 2022, 9 (3) e1156; DOI: 10.1212/NXI.0000000000001156

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    Figure 1 Geographic Distribution of Cryptococcal Meningitis Cases Reported With Fingolimod Treatment

    UAE = United Arab Emirates; UK = United Kingdom; US = the United States.

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    Figure 2 Incidence of CM per 1,000 Patients by Year of Treatment

    CM = Cryptococcal meningitis.

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