Case Reports: Ischemic Strokes in a Young Woman With Manifestations of Multiple Sclerosis

Alemtuzumab is an anti-CD52 monoclonal antibody used to treat relapsing-remitting multiple sclerosis following failure of second-line medications. It is administered intravenously in 2 treatment sequences 1 year apart. This drug is frequently associated with mild infusion reactions within days of administration, increased infection risk, and long term adverse events from secondary autoimmunity. Alemtuzumab-induced serious immune-mediated thrombocytopenia (ITP) is well-reported and occurred in 1.0-2.2% of participants in initial phase 2 and 3 trials for multiple sclerosis. Significant neutropenia, however, is rare and was only observed in 0.1% of study participants. Delayed neutropenia and/or ITP is thought to occur from secondary autoimmunity. Few case reports have described severe neutropenia occurring beyond 2 months of last alemtuzumab dose. We present an unusual case of delayed combined neutropenia and thrombocytopenia that occurred 15 months after the second infusion of alemtuzumab. The patient was asymptomatic and presented following discovery of neutropenia and thrombocytopenia during routine laboratory studies. The patient responded to steroids initially and was discharged, although outpatient cell counts subsequently revealed recurrent neutropenia and ITP. The adverse drug reaction probability (Naranjo) scale was completed and showed probable likelihood that the adverse event was alemtuzumab-related. Long term screening for delayed hematologic abnormalities, at least 4 years after initial dose, is necessary when using alemtuzumab. Greater research is needed to understand the mechanism of drug-associated neutropenia.

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De novo convulsive status epilepticus in patients with multiple sclerosis treated with dalfampridine

Multiple Sclerosis Journal ◽

10.1177/1352458518790379 ◽

2018 ◽

Vol 25 (4) ◽

pp. 618-621 ◽

Cited By ~ 3

Author(s):

Emilie Panicucci ◽

Mikael Cohen ◽

Veronique Bourg ◽

Fanny Rocher ◽

Pierre Thomas ◽

...

Keyword(s):

Multiple Sclerosis ◽

Status Epilepticus ◽

De Novo ◽

Case Reports ◽

Brain Magnetic Resonance Imaging ◽

Convulsive Status Epilepticus ◽

Biological Tests ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

History Of Epilepsy

Background: Dalfampridine extended release (DAL) is a broad-spectrum voltage-gated potassium channel blocker that is indicated in multiple sclerosis to improve the nerve conduction of demyelinated axons. Seizures are a known side effect of DAL, which is contraindicated in patients with a history of epilepsy. Objective: Three cases of multiple sclerosis (MS) with de novo convulsive status epilepticus (CSE) probably related to dalfampridine administration are described. Methods: No patients had a history of seizures or renal impairment. Biological tests were normal. A brain magnetic resonance imaging (MRI) showed diffuse cortical and subcortical atrophy without active inflammatory lesions. Results: All three patients presented with CSE that was attributed to DAL and so was discontinued. Conclusion: These case reports illustrate that, aside from seizures, de novo CSE is a potential complication of MS patients treated with DAL.

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Active Pulmonary Tuberculosis Triggered by Interferon Beta-1b Therapy of Multiple Sclerosis: Four Case Reports and a Literature Review

Medicina ◽

10.3390/medicina56040202 ◽

2020 ◽

Vol 56 (4) ◽

pp. 202 ◽

Cited By ~ 2

Author(s):

Carmen Adella Sirbu ◽

Elena Dantes ◽

Cristina Florentina Plesa ◽

Any Docu Axelerad ◽

Minerva Claudia Ghinescu

Keyword(s):

Multiple Sclerosis ◽

Mycobacterium Tuberculosis ◽

Literature Review ◽

Interferon Beta ◽

Latent Infection ◽

Case Reports ◽

Active Tuberculosis ◽

Active Pulmonary Tuberculosis ◽

Disease Modifying Therapies ◽

Disease Modifying

In this paper, we reported on four cases of severe pulmonary active tuberculosis in patients with multiple sclerosis (MS) undergoing interferon beta-1b (IFNβ-1b) therapy. Disease-modifying therapies (DMTs) in MS may increase the risk of developing active tuberculosis (TB) due to their impact on cellular immunity. Screening for latent infection with Mycobacterium tuberculosis (LTBI) should be performed, not only for the newer DMTs (alemtuzumab, ocrelizumab) but also for IFNβ-1b, alongside better supervision of these patients.

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An Unusual Case of Collagenous Gastritis: Incidental Finding in a Patient Presenting with Dysphagia

Case Reports in Gastrointestinal Medicine ◽

10.1155/2019/5427085 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Chiu-Hsiang Liao ◽

Maruf Saddik ◽

Stephen Ip

Keyword(s):

Gastric Mucosa ◽

Young Woman ◽

Unusual Case ◽

Incidental Finding ◽

Case Reports ◽

Collagen Deposition ◽

Inflammatory Infiltrates ◽

Collagenous Gastritis

Collagenous gastritis is a condition characterized by subepithelial deposition of collagen in the gastric mucosa. This condition is rare, with less than 100 cases reported in the literature. Patients with collagenous gastritis typically present with pain or diarrhea. Here, we present a case of a young woman with dysphagia who was found to have esophageal webs and an incidental finding of diffuse gastritis with a cobblestone appearance of the mucosa on endoscopy. Subsequent histology demonstrated features of collagenous gastritis, including mucosal inflammatory infiltrates and collagen deposition. This is one of the few case reports of incidental collagenous gastritis and highlights the importance of judicious use of biopsies.

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Sclerosing skin disorders in association with multiple sclerosis. Coincidence, underlying autoimmune pathology or interferon induced?: Table 1

Annals of the Rheumatic Diseases ◽

10.1136/ard.2007.083246 ◽

2008 ◽

Vol 68 (1) ◽

pp. 47-50 ◽

Cited By ~ 21

Author(s):

T Hügle ◽

S Gratzl ◽

T Daikeler ◽

D Frey ◽

A Tyndall ◽

...

Keyword(s):

Multiple Sclerosis ◽

Antinuclear Antibodies ◽

Case Reports ◽

Early Age ◽

Antisynthetase Syndrome ◽

Skin Disorders ◽

Skin Sclerosis ◽

Autoimmune Pathology ◽

Relapsing Remitting ◽

The Mean

Objectives:To describe and analyse the manifestation of sclerosing skin disorders in patients with multiple sclerosis (MS).Case reports:We describe three patients with relapsing-remitting MS who developed skin sclerosis while receiving interferon (IFN)-β treatment and review nine further cases of systemic sclerosis (SSc) in MS from the literature. Of all 12 patients reported, eight had limited cutaneous SSc, three had diffuse cutaneous SSc and one patient had an antisynthetase syndrome. Localised scleroderma such as morphoea was not described. The mean age at diagnosis was 25.2 years for MS (range 12 to 51) and 38.3 years for SSc (range 16 to 66). Eleven patients developed SSc after the onset of MS and manifested with skin sclerosis after a mean of 14.9 years (range 1 to 45). In five patients IFN-β was commenced before the development of skin sclerosis (mean 4.6 years, range 1 to 8 years). There was no relationship between the onset of skin sclerosis and MS activity. With the exception of one individual, all patients had antinuclear antibodies.Conclusions:Sclerosing skin disorders may develop in the course of MS. The relatively early age of SSc onset in patients with MS suggests a genetic predisposition and/or an IFN-associated trigger.

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A Young Woman with Multiple Sclerosis and Hand Numbness

Neuromuscular Case Studies ◽

10.1016/b978-0-7506-7332-7.50015-5 ◽

2008 ◽

pp. 129-133

Author(s):

Tulio E. Bertorini

Keyword(s):

Multiple Sclerosis ◽

Young Woman

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040 An analysis of malignancy risk in the clinical development programme of cladribine tablets in patients with relapsing multiple sclerosis

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-anzan.39 ◽

2018 ◽

Vol 89 (6) ◽

pp. A17.1-A17

Author(s):

Andrew Galazka ◽

Axel Nolting ◽

Stuart Cook ◽

Thomas Leist ◽

Giancarlo Comi ◽

...

Keyword(s):

Multiple Sclerosis ◽

Case Reports ◽

Meta Analysis ◽

Reference Population ◽

Phase Iii ◽

Disease Modifying Drugs ◽

Malignancy Risk ◽

Phase Iii Trials ◽

Relapsing Multiple Sclerosis

IntroductionAn independent meta-analysis; Pakpoor et al. Neurol Neuroimmunol Neuroinflamm 2015;2:e158) in Phase III trials (with a 2 year duration) of disease modifying drugs (DMDs) in patients with relapsing multiple sclerosis found no increased rate of malignancy with cladribine tablets (CT) versus other DMD treatments. Data from additional trials involving CT 3.5 mg/kg (CT3.5) and a safety registry (up to 8 years’ follow-up) allow further insights into malignancy risk. Objective is to assess malignancy risk with CT3.5 monotherapy and placebo (PBO) in data from 3 Phase III trials and a registry, and compare the incidence rate with a global database.MethodsThe CT 3.5 population comprised 923 patients (3433 patient-years’ [PY] total exposure time) and the PBO group comprised 641 patients (2026 PY). Individual case reports of malignancies were reviewed by independent, blinded adjudication committee. Standardised incidence ratios (SIR) were calculated using the GLOBOCAN reference population (excluding non-melanoma skin cancers [NMSCs]) and a Danish reference population for NMSC rates.ResultsThe incidence per 100 PY of confirmed malignancy was CT3.5 0.293 (95%CI 0.158–0.544) and PBO 0.148 (95%CI 0.048–0.460); the risk difference 95% CI included 0 (−0.166–0.414). The CT 3.5 malignancy SIR was almost identical (0.97, 95% CI 0.44–1.85) to the GLOBOCAN matched reference population. The PBO group SIR was numerically lower (0.48, 95% CI 0.14–1.53). There were no cases of haematological, lymphoproliferative or virus-induced cancers. There was no clustering of specific tumour types, and the incidence of skin cancer was not increased after treatment with CT3.5 versus PBO. The incidence of malignancies with CT3.5 was constant and did not increase over time.ConclusionAnalysis of malignancy rates in a cohort that includes patients with up to 8 years’ follow-up confirms the Conclusion of the earlier meta-analysis; the incidence of malignancies with CT3.5 is similar to a matched reference population.

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