Table 1.
Case demographics and other parameters
| Case 1 | Case 2 | Case 3 | |
| Year at ITP diagnosis | 2014 | 2013 | 2014 |
| Age (years) | 22 | 59 | 51 |
| Sex | F | F | F |
| MS duration (years) | 3 | 2 | 10 |
| MS course | 2012: right optic neuritis with MRI brain: T2 frontal white matter lesion 2013: MRI brain: new T2 lesion 2013: right optic neuritis |
2011 July: left optic neuritis with MRI brain: equivocal cerebral peduncle T2 lesion only 2011 September: right-sided weakness and dysarthria MRI brain: supra and infratentorial T2 lesions |
1994: left-sided weakness and spasticity Imaging studies not available 1997: relapse of left-sided weakness and spasticity |
| Previous MS therapy | 2013: dimethyl fumarate→ lymphopenia requiring cessation 2014 | October 2011: beta interferon → persistent lymphopenia and neutropenia prompting cessation 2012–2013 | 1997: beta interferon |
| Other autoimmune conditions | – | Rheumatoid arthritis Graves’ disease |
– |
| Autoimmune testing/H. pylori screening | Negative | Negative | Negative |
| Viral screening at initial presentation (HBV, HCV, HIV, CMV, EBV) | Negative | Negative | Negative |
| Protein electrophoresis | Negative | Negative | Negative |
| Evidence of splenomegaly | None clinically | None clinically | None clinically |
| Bone marrow biopsy | Not undertaken | Not undertaken | June 2014: normal trilineage haematopoiesis with plentiful megakaryocytes |
| Duration of fingolimod prior to ITP | 12 months | 2 months | 19 months |
| Fingolimod dose | 0.5 mg alternate daily | 0.5 mg daily | 0.5 mg daily |
| Fingolimod post thrombocytopenia | Continued | Continued | Discontinued |
| ITP treatment | Prednisolone | Prednisolone IVIg azathioprine hydroxychloroquine |
Prednisolone IVIg azathioprine hydroxychloroquine Eltrombopag Romiplostim |
| Time to CR (months) | 0.4 | 2.5 | 0.2 |
| ITP relapses (Plt <30×109/L) | Nil | Nil | Five (one precipitated by fingolimod reinitiation) |
| Duration of ITP treatment (months) | 6.7 | 25.2 | 15.7 (ongoing) |
CMV, cytomegalovirus; CR, complete remission; EBV, Epstein-Barr virus; HBV, hepatitis B virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus; H. pylori, Helicobacter pylori; ITP, immune thrombocytopenic purpura; MS, multiple sclerosis; Plt, platelets.