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Abstract Details

Autoimmune Hemolytic Anemia after Treatment with Fingolimod: A Case Report
Multiple Sclerosis
P4 - Poster Session 4 (5:30 PM-6:30 PM)
15-038

We report a case of autoimmune hemolytic anemia in a patient with multiple sclerosis treated with Fingolimod.

Fingolimod is a selective sphingosine 1-phosphate receptor (S1PR) modulator widely used for the treatment of relapsing multiple sclerosis.It is known to inhibit egress of lymphocytes from lymphoid tissues, potentially reducing trafficking of pathogenic cells into the central nervous system. Fingolimod is associated with a few adverse events including cardiac arrhythmias, macular edema and severe lymphopenia, but it has not been linked to autoimmunity.

Case report
A 52-year-old woman with relapsing multiple sclerosis presented with gradual fatigue and shortness of breath on exertion one year after Fingolimod was initiated. She was found to have anemia with a red cell count of 2.48 M/uL. Subsequent workup by hematology showed a reticulocyte count of 13%, undetectable haptoglobin, positive Coombs direct C3D and IgG antibodies, confirming autoimmune hemolytic anemia. Fingolimod was discontinued and the patient was treated with IV methylprednisolone followed by oral steroids tapered off over one month period. Two months after Fingolimod was discontinued, her red cell count normalized and it has remained normal.
This is the second case of autoimmune hemolytic anemia described in a patient treated with Fingolimod. In our opinion, the causal relationship is clear as we describe a visible temporal association between the initiation of Fingolimod and the development of anemia. In addition, the patient’s red cell count has remained normal since Fingolimod was discontinued.
Authors/Disclosures
Arif Husain, DO (NYU Brooklyn)
PRESENTER 		No disclosure on file
Nada G. Abou Fayssal, MD, FAAN (NYU Langone Brooklyn Campus) Dr. Abou Fayssal has nothing to disclose.