Severe COVID-19 infection in a patient with multiple sclerosis treated with fi ngolimod
Severe COVID-19 infection in a patient with multiple sclerosis treated with fi ngolimod
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DOI：
10.1016/j.msard.2020.102180
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发表时间：
2020-07-01
影响因子：
4
通讯作者：
Adam, Elisabeth H.
中科院分区：
文献类型：
--
作者：
Foerch, Christian;Friedauer, Lucie;Adam, Elisabeth H.
背景：芬戈莫德用于多发性硬化症患者的免疫治疗。长期治疗会导致疱疹病毒再激活和呼吸道感染的风险略有增加。尚未描述接受芬戈莫德治疗的 2019 年冠状病毒病 (COVID-19) 患者。方法和结果：我们报告了一名正在接受芬戈莫德治疗的复发缓解型多发性硬化症的 57 岁女性患者，她于 2020 年 3 月经历了严重的 COVID-19 感染（扩展残疾状态量表：2.0）。患者具有芬戈莫德治疗典型的外周淋巴细胞减少症（淋巴细胞总数0.39/nL [参考范围1.22-3.56]），患者出现双侧间质性肺炎，胸部CT显示多发磨玻璃影。芬戈莫德药物已停止。在重症监护室，采用无创通气定期提供氧气和通气支持。接下来的两天里，氧合有所改善，患者入院五天后转入普通病房。结论：芬戈莫德对 COVID-19 的影响是复杂的。作为 S1P 类似物，芬戈莫德可能增强肺内皮细胞的完整性。此外，在发生所谓的细胞因子风暴的情况下，免疫调节可能有助于降低死亡率。需要未来的研究来探讨芬戈莫德对 COVID-19 患者的风险和治疗效果。
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 [re- ference 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 im- proved, 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.