A 62-year-old woman with multiple sclerosis treated with fingolimod for 3 years presented to the clinic with a tender nodule on her forehead, which had gradually grown over 3 weeks (Figure). She reported bumping her forehead on an air-conditioning unit several months prior. She denied fever, neck stiffness, and photophobia, and her neurological examination was at her baseline. She lived alone with a pet cat and spent minimal time outdoors. She had no recent exposure to systemic steroids.
Forrestel AK, Modi BG, Longworth S, Wilck MB, Micheletti RG. Primary Cutaneous Cryptococcus in a Patient With Multiple Sclerosis Treated With Fingolimod. JAMA Neurol. 2016;73(3):355-356. doi:10.1001/jamaneurol.2015.4259