A case report with tuberculous meningitis during fingolimod treatment

Objective: We aimed to describe a case study of tuberculous meningitis in a patient with multiple sclerosis (MS) receiving fingolimod.

Case report: A-Thirty-five-year-old woman with MS started interferon beta-1b treatment in 2016. Due to frequent relapses and disability accumulation, her treatment was switched to fingolimod in 2018. The patient presented with subacute headache, fever, confusion, nausea, and vomiting after one year of treatment with fingolimod. Her cerebrospinal fluid (CSF) examination yielded a lymphocytic pleocytosis, elevated protein level, and decreased glucose levels. Her brain magnetic-resonance-images (MRI) showed contrast enhancement of meninges without any new demyelinating lesions. Mycobacterium tuberculosis was isolated in her CSF culture. After using anti-tuberculosis treatment for nine months, the patient's infection resolved entirely without any disability related to meningitis. Then, the fingolimod therapy was switched to glatiramer acetate.

Conclusion: Herein, we report the first case with fingolimod-associated meningitis during Mycobacterium tuberculosis in a patient with MS. Clinicians should keep in mind that fingolimod treatment may reactivate latent tuberculosis, especially in endemic regions.

Keywords: Fingolimod; Meningitis; Multiple sclerosis; Tuberculosis.