Leprosy in two patients with Relapsing Remitting Multiple Sclerosis (RRMS) treated with Fingolimod (P4.2-012)

Objective: To describe two patients who acquired leprosy while being treated with Fingolimod for RRMS. Background: Leprosy (Hansen’s disease) is a chronic infection caused by Mycobacterium leprae. The disease develops over months to years and may cause extensive damage to the skin and peripheral nervous system. In Multiple Sclerosis (MS), Fingolimod treatment is known to increase the risk for infections. There is one prior reported case of leprosy while on Fingolimod for RRMS. We report two further cases of leprosy in patients with RRMS and treated with Fingolimod. Design/Methods: Retrospective chart review of patient records of individuals with MS treated with Fingolimod, followed at the Maxine Mesinger Multiple Sclerosis Clinic at Baylor College of Medicine, Houston, TX, USA. Results: Two female patients [63 (P1) and 71 (P2) years old] with a diagnosis of leprosy were identified. The diagnosis was made via skin biopsy and the mean time of diagnosis from the initiation of Fingolimod was 34.5 months. P1’s absolute lymphocyte count (ALC) was 451 seven months prior to the diagnosis. P2’s ALC was 118 two months prior to the diagnosis. Both patients were potentially exposed to armadillo feces. They were placed on triple antibiotic therapy and were continued on Fingolimod without any complications. Conclusions: Here we report two additional patients with RRMS diagnosed with leprosy while on Fingolimod. The exact cause and effects between Fingolimod and leprosy is unclear at this time; however, the patients have had a low ALC around the diagnosis and were identified to have a history of potential exposure. Disclosure: Dr. Balasa has nothing to disclose. Dr. Hutton has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Genzyme. Dr. Hutton has received research support from Biogen Idec, Hoffman LaRoche, Genzyme, MedImmune, Malinckrodt, Novastis, Adamas.