Extensive molluscum contagiosum virus infection in a young adult receiving fingolimod

Abstract

Fingolimod-related viral infections have been described on several occasions since its introduction in 2010. We hereby add a report on an otherwise immunocompetent, 18-year old Caucasian man with relapsing-remitting multiple sclerosis who developed a protracted and extensive molluscum contagiosum (MC) virus infection shortly after being started on fingolimod. Wide-spread cutaneous MC infections in adult patients are considered indicative of underlying immunosuppression. Neurologists prescribing fingolimod ought to be aware of a possibly increased risk of MC, but also need to know about its relative benignity, lack of extra-cutaneous complications, and adequate treatment options.

ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Immune checkpoint inhibitors, cell adhesion inhibitors, sphingosine-1-phosphate receptor modulators and proteasome inhibitors)

“…Apart from herpesvirus infections, other infections typically associated with immunosuppression have been described in patients treated with fingolimod, including primary cutaneous cryptococcosis [103], cryptococcal meningitis [104,105], and visceral leishmaniasis [106]. A young MS patient developed extensive molluscum contagiosum infection (around 150 lesions) [107], a phenotype that resembles that observed among HIV-infected patients with very low CD4+ T-cell counts.…”

Atypical molluscum contagiosum on multiple sclerosis patients treated with fingolimod: A case report

“…Molluscum contagiosum (MC) is a skin infection caused by a virus of the DNA poxvirus family. It has already been reported by Fingolimod 4 . Due to the rarity of MC reported with fingolimod, we have given an account of two cases, among our patients, with this skin infection.…”

“…It has already been reported by Fingolimod. 4 Due to the rarity of MC reported with fingolimod, we have given an account of two cases, among our patients, with this skin infection.…”

Disseminated molluscum contagiosum associated with immunomodulatory therapy

“…Increased rates and severity of viral infections, particularly with varicella zoster and human papilloma virus, as well as 1 other case of disseminated molluscum contagiosum, have been reported in patients receiving fingolimod. 4 , 6 , 7 Although each medication was likely contributory, the effect of fingolimod seemed particularly deleterious because improvement was noted only after its discontinuation.…”

“…Adult patients who are immunosuppressed may develop many lesions in this distribution or have widespread disease. 1 , 2 , 3 , 4 Although lesions in immunosuppressed patients may present classically as pink or skin-colored umbilicated papules, they may also be large or verrucous. 1 Immunosuppressed patients with molluscum contagiosum have a protracted disease course.…”