BMJ Case Reports 2017; doi:10.1136/bcr-2017-220590
  • Unexpected outcome (positive or negative) including adverse drug reactions

Immune thrombocytopenic purpura associated with fingolimod

  1. George Grigoriadis2
  1. 1Department of Haematology, Monash Health, Clayton, Victoria, Australia
  2. 2Department of Clinical Haematology, Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Dr George Grigoriadis, george.grigoriadis{at}
  • Accepted 25 August 2017
  • Published 11 September 2017


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 weeks. Here we report three such cases.

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.

There was a temporal association between fingolimod exposure and ITP however dose–effect association and pathogenesis remain less clear.

In conclusion, our cases highlight that clinicians should be aware of the possible association between ITP and fingolimod.


  • EHA Scientific Conference on Bleeding Disorders 2016

  • Contributors HLAY: wrote the case series. GG, NC and SB: contributed cases and reviewed the case series.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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