Multiple sclerosis and Autoimmune hemolytic anemia induced by Fingolimod: A Case Report and literature review of the most important drugs induce AIHA in MS therapy

Introduction: Multiple Sclerosis (MS) is the central nervous system (CNS) chronic inflammatory disease have been afflicted millions of people around the world. ngolimod(FTY720) as food and drug administration (FDA) approved oral medication is in order to rehabilitate relapsing-remitting MS(RRMS) since 2010. A questionable drug-induced auto-immune hemolytic anemia(diAIHA) within the multiple MS medications are reported currently. Though few studies represent a correlation between scarce AEs anemia and MS, neither support anemia and MS simultaneous attendance or priority of happening.Case report: 43-year-old woman with multiple sclerosis treated by fingolimod for more than 2 years, showed jaundice and decrease in Hb serum level. Direct antiglobulin test(DAT) revealed a positive result indicating autoimmune hemolytic anemia(AIHA) induced by MS therapy. Until now, some alike cases have been reported to cause drug induced AIHA(diAIHA). To best of our knowledge, we report the second case of AIHA exerted by fingolimod. Procedures, in order to revive mentioned patients in to the stable hemodynamic state have been explained beside each sign of anemia at the onset of the MS therapy complication. Probable actions that would be recognized in each similar case is also mentioned from the other above.Conclusion: AIHA can happen in routine MS implementation therapy. We focused on Fingolimod exerted AEs and explained other 5 accepted diAIHA in this way. However, there is no obvious explanation of how Fingolimod can action on RBC and why just a minor group of patients have been suffering from this adverse effect is still remained an obscure question.

کلیدواژه ها:

Multiple sclerosis ، autoimmune hemolytic anemia ، Fingolimod ، Interferon beta-1b ، Alemtuzumab ، Dimethyl Fumarate