HPV-associated Anal and Genital Intraepithelial Neoplasia After Using Fingolimod in the Treatment of Relapsing-remitting Multiple Sclerosis: A Case Report

Multiple sclerosis (MS) is a chronic, autoimmune, neurodegenerative disease of the central nervous system, with inflammation and loss of myelin in axons. Fingolimod is the first oral disease-modifying agent approved for the treatment of relapsing-remitting MS. Here we aimed to present a patient with MS who developed human papillomavirus (HPV)-associated anal and genital intraepithelial neoplasia while on fingolimod treatment. A 19-year-old female patient presented with the complaint of diplopia. The diagnosis of MS was made based on imaging and cerebrospinal fluid results. She was treated first with beta-interferon 1a, then methotrexate, and finally fingolimod. While the patient was being followed without attack under fingolimod treatment, HPV-associated genital, and further, anal warts developed. This is a rare case that developed both cervical dysplasia and anal Condyloma acuminatum due to the HPV that developed after fingolimod treatment in a patient with MS. In conclusion, fingolimod treatment increases the risk of cervical HPV infection and related cancer in patients with MS.