Herpes zoster laryngitis in a patient treated with fingolimod. Issue 12 (December 2016)

• Record Type: Journal Article
• Authors: Hagiya, Hideharu; Yoshida, Hisao; Shimizu, Mikito; Motooka, Daisuke; Nakamura, Shota; Iida, Tetsuya; Yamamoto, Norihisa; Akeda, Yukihiro; Tomono, Kazunori
• Is Part Of: Journal of infection and chemotherapy. Volume 22:Issue 12(2016:Dec.)
• Page Start: 830
• Page End: 832
• Publication Date: 2016-12
• Subjects: Fingolimod -- Herpes zoster virus -- Laryngopharyngitis -- Metagenomic analysis -- Next-generation sequencing technology; Chemotherapy -- Periodicals; Infection -- Periodicals; Communicable diseases -- Chemotherapy -- Periodicals; 615.5805
• DOI: 10.1016/j.jiac.2016.07.011
• Languages: English
• ISSNs: 1341-321X

Abstract

Abstract: Development of treatment with immunomodulatory agents has improved prognosis of various autoimmune-related diseases. A sphingosin-1-phosphate receptor modulator, or fingolimod, is the first licensed oral drug for relapsing-remitting multiple sclerosis. The agent reduces circulating lymphocytes by trapping T cells in lymph nodes, possibly leading to reactivation of latent viruses. A 41-year-old Japanese woman who had been treated with fingolimod for 2 years presented with unilateral sore throat. Laryngoscopy revealed exudates unilaterally emerging on the left side of her supraglottic region. Serum level of the varicella zoster virus (VZV)-specific IgG was markedly elevated, and a result of genome sequence using the exudates demonstrated VZV as a possible causative pathogen. Fingolimod therapy was discontinued and the patient was successfully treated with intravenous acyclovir. This is the first reported case of fingolimod-associated herpes zoster laryngitis, in which the local VZV reactivation was demonstrated by next-generation sequencing technology. The present case highlights that the occurrence of VZV reactivation should be recalled in any patients undergoing fingolimod therapy.