Oral HPV-Related Epithelial Proliferation during Fingolimod Therapy: First Case Report and Review of the Literature

Kittiphoj Tikkhanarak; Jay Saepoo; Nidhi Handoo; Emily Lanzel; Sherry Timmons; Ryan Frost; John Hellstein

doi:10.1007/s12105-025-01881-0

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Oral HPV-Related Epithelial Proliferation during Fingolimod Therapy: First Case Report and Review of the Literature

Journal article

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Peer reviewed

Oral HPV-Related Epithelial Proliferation during Fingolimod Therapy: First Case Report and Review of the Literature

Kittiphoj Tikkhanarak, Jay Saepoo, Nidhi Handoo, Emily Lanzel, Sherry Timmons, Ryan Frost and John Hellstein

Head & neck pathology (Totowa, N.J.), Vol.20(1), 8

01/08/2026

DOI: 10.1007/s12105-025-01881-0

PMCID: PMC12783387

PMID: 41505028

Appears in UI Libraries Support Open Access

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Abstract

Fingolimod, an immunomodulatory agent used in the treatment of multiple sclerosis, has been associated with an increased risk of human papillomavirus (HPV)-related mucocutaneous lesions due to its immunosuppressive effects. We report the first documented case of oral mucosal HPV-related epithelial proliferation in a patient undergoing long-term fingolimod therapy. A 36-year-old male presented with multiple mildly papillomatous gingival lesions, during ongoing fingolimod (Gilenya ) therapy for eight years. Histopathologic examination revealed parakeratinized stratified squamous epithelium with acanthosis, papillary projections supported by fibrovascular cores, and koilocytosis. HPV DNA testing demonstrated the presence of low-risk HPV types 6/11. The clinical presentation, histopathologic features, and supporting laboratory findings, in the context of long-term immunomodulatory therapy, were consistent with an HPV-related epithelial proliferation potentially associated with fingolimod use. This case expands the anatomic spectrum of HPV-associated epithelial proliferations as a potential adverse effect of fingolimod therapy in patients with multiple sclerosis, broadening clinical awareness beyond the reported cutaneous and anogenital presentations.

Adult

Fingolimod Hydrochloride - adverse effects

Humans

Immunosuppressive Agents - adverse effects

Male

Multiple Sclerosis - drug therapy

Papillomavirus Infections - chemically induced

Papillomavirus Infections - pathology

UIOWA OA Agreement

Details

Title: Subtitle: Oral HPV-Related Epithelial Proliferation during Fingolimod Therapy: First Case Report and Review of the Literature
Creators: Kittiphoj Tikkhanarak - University of Iowa
Jay Saepoo - University of Iowa
Nidhi Handoo - University of Iowa
Emily Lanzel - University of Iowa
Sherry Timmons - University of Iowa
Ryan Frost
John Hellstein - University of Iowa
Resource Type: Journal article
Publication Details: Head & neck pathology (Totowa, N.J.), Vol.20(1), 8
DOI: 10.1007/s12105-025-01881-0
PMID: 41505028
PMCID: PMC12783387
NLM abbreviation: Head Neck Pathol
ISSN: 1936-055X
eISSN: 1936-0568
Publisher: Springer Nature
Language: English
Date published: 01/08/2026
Academic Unit: Oral Pathology, Radiology and Medicine; Dentistry Administration
Record Identifier: 9985116068902771

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