{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:08:26Z","timestamp":1787242106896,"version":"build-2736575974"},"reference-count":16,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,8,25]]},"abstract":"<jats:p>Fingolimod is an oral sphingosine-1-phosphate receptor modulator which causes lymphocyte sequestration in lymph nodes and is approved for relapsing multiple sclerosis. The Therapeutic Goods Administration of Australia is aware of only one case where fingolimod preceded immune thrombocytopenic purpura (ITP) by 5\u2009weeks. Here we report three such cases.<\/jats:p>\n                  <jats:p>None were on any medications known to cause ITP and routine investigations were unremarkable. All cases were treated with immunosuppression. Case 1 successfully weaned prednisolone after fingolimod cessation whereas case 2 weaned slowly while continuing fingolimod therapy. Case 3 had more refractory ITP and re-exposure to fingolimod worsened thrombocytopenia.<\/jats:p>\n                  <jats:p>There was a temporal association between fingolimod exposure and ITP however dose\u2013effect association and pathogenesis remain less clear.<\/jats:p>\n                  <jats:p>In conclusion, our cases highlight that clinicians should be aware of the possible association between ITP and fingolimod.<\/jats:p>","DOI":"10.1136\/bcr-2017-220590","type":"journal-article","created":{"date-parts":[[2017,9,11]],"date-time":"2017-09-11T08:50:12Z","timestamp":1505119812000},"page":"bcr-2017-220590","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Immune thrombocytopenic purpura associated with fingolimod"],"prefix":"10.1136","volume":"2017","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8349-6782","authenticated-orcid":false,"given":"Hiu Lam Agnes","family":"Yuen","sequence":"first","affiliation":[{"name":"Department of Haematology, Monash Health, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Haematology, Monash Health, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noel","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Haematology, Monash Health, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Grigoriadis","sequence":"additional","affiliation":[{"name":"Department of Clinical Haematology, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,9,11]]},"reference":[{"key":"2025082702125974000_2017.sep08_1.bcr-2017-220590.1","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.C200176200"},{"key":"2025082702125974000_2017.sep08_1.bcr-2017-220590.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0907839"},{"key":"2025082702125974000_2017.sep08_1.bcr-2017-220590.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0909494"},{"key":"2025082702125974000_2017.sep08_1.bcr-2017-220590.4","unstructured":"FDA. FDA Drug Safety Communication: FDA warns about cases of rare brain infection with MS drug Gilenya (fingolimod) in two patients with no prior exposure to immunosuppressant drugs 2015. http:\/\/www.fda.gov\/Drugs\/DrugSafety\/ucm456919.htm."},{"key":"2025082702125974000_2017.sep08_1.bcr-2017-220590.5","unstructured":"European Medicines Agency. Gilenya: Scientific conclusions and grounds recommending the variation to the terms of the marketing authorisation 2014. http:\/\/www.ema.europa.eu\/docs\/en_GB\/document_library\/EPAR_-_Scientific_Conclusion\/human\/002202\/WC500169779.pdf."},{"key":"2025082702125974000_2017.sep08_1.bcr-2017-220590.6","doi-asserted-by":"crossref","first-page":"NA","DOI":"10.1002\/ajh.21616","article-title":"The incidence of immune thrombocytopenic purpura in children and adults: A critical review of published reports","volume":"85","author":"Terrell","year":"2010","journal-title":"Am J Hematol"},{"key":"2025082702125974000_2017.sep08_1.bcr-2017-220590.7","first-page":"22","volume-title":"Methylprednisolone","volume":"1477","year":"2013"},{"key":"2025082702125974000_2017.sep08_1.bcr-2017-220590.8","doi-asserted-by":"publisher","DOI":"10.1186\/1742-2094-5-27"},{"key":"2025082702125974000_2017.sep08_1.bcr-2017-220590.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejphar.2007.04.053"},{"key":"2025082702125974000_2017.sep08_1.bcr-2017-220590.10","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1111\/bcp.12454","article-title":"Effect of fingolimod (FTY720) on cerebral blood flow, platelet function and macular thickness in healthy volunteers","volume":"78","author":"Ocwieja","year":"2014","journal-title":"Br J Clin Pharmacol"},{"key":"2025082702125974000_2017.sep08_1.bcr-2017-220590.11","first-page":"295","article-title":"The environment\u00a0and disease: association or caution?","volume":"58","author":"Hill","year":"1965","journal-title":"Proc R Soc Med"},{"key":"2025082702125974000_2017.sep08_1.bcr-2017-220590.12","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20121090"},{"key":"2025082702125974000_2017.sep08_1.bcr-2017-220590.13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2006.02147.x"},{"key":"2025082702125974000_2017.sep08_1.bcr-2017-220590.14","doi-asserted-by":"publisher","DOI":"10.1177\/1352458513493035"},{"key":"2025082702125974000_2017.sep08_1.bcr-2017-220590.15","doi-asserted-by":"crossref","first-page":"P2.206","DOI":"10.1212\/WNL.82.10_supplement.P2.206","article-title":"A case Of hemophagocytic lymphohistiocytosis syndrome in a patient with multiple sclerosis On fingolimod therapy","volume":"82","author":"Abreu","year":"2014","journal-title":"Neurology"},{"key":"2025082702125974000_2017.sep08_1.bcr-2017-220590.16","doi-asserted-by":"crossref","first-page":"e247","DOI":"10.1212\/NXI.0000000000000247","article-title":"HSV-2-related hemophagocytic lymphohistiocytosis in a fingolimod-treated patient with MS","volume":"3","author":"Ikumi","year":"2016","journal-title":"Neurol Neuroimmunol Neuroinflamm"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-220590","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:13:10Z","timestamp":1756285990000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-220590"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,11]]},"references-count":16,"alternative-id":["10.1136\/bcr-2017-220590"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-220590","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9,11]]}}}