BackgroundDiffuse alveolar bleeding is a potentially life-threatening condition that can be induced by several drugs. Whereas fatal cases have been reported in patients treated for other indications, no report have so far been published in a patient with multiple sclerosis treated with alemtuzumab.Case presentationWe report a case of alemtuzumab-induced diffuse alveolar bleeding in a 29 year old woman with relapsing remitting multiple sclerosis. The patient developed acute shortness of breath, chest pain on inspiration and haemoptysis following the second infusion of alemtuzumab during the first treatment cycle. Computed tomography showed bilateral alveolar opacities. Bronchoscopy and broncho-alveolar lavage showed persistently bloody return with no evidence of infection. The symptoms resolved completely without treatment and control computed tomography performed one week later showed total resolution of pulmonary infiltrates.ConclusionThis is the first published report of diffuse alveolar bleeding in a patient with multiple sclerosis treated with alemtuzumab. Four similar cases in patients treated for multiple sclerosis and several fatal cases in patients treated for other conditions are registered at the World Health Organization database of suspected adverse events (VIgiBase©), underscoring that this is a serious and possibly under-recognized complication of alemtuzumab which can also occur in the treatment of multiple sclerosis. The clinician should consider the possibility of diffuse pulmonary haemorrhage in patients with sudden onset of respiratory distress and haemoptysis following administration of alemtuzumab for multiple sclerosis.
BackgroundLeber’s hereditary optic neuropathy (LHON) co-occuring with multiple sclerosis-like disease (LHON-MS) is suggested to be a separate disease entity denoted Harding’s disease. Little is known about the response to initiation and discontinuation of potent immunomodulatory treatment in LHON-MS.Case presentationWe describe a LHON-MS patient with 27 years disease duration who developed severe disease activity peaking 14 months after discontinuation of natalizumab, with extensive new inflammatory lesions throughout the brain and in the spinal cord resembling immune inflammatory reconstitution syndrome. She had previously been clinically and radiologically stable on natalizumab treatment for 6 years, and before that only experienced subtle clinical activity during 9 years on interferon beta1a.ConclusionThis is the first report on severe exacerbation of inflammatory disease activity after discontinuation of natalizumab in LHON-MS, and suggests that late rebound activity can occur in these patients.
Nevroklinikken Akershus universitetssykehus Silje Holt Jahr er lege i spesialisering. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. AIJA ZULERON MYRO Nevroklinikken Akershus universitetssykehus Aija Zuleron Myro er overlege i nevrologi. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. KJETIL VEGGE Bildediagnostisk avdeling Akershus universitetssykehus Kjetil Vegge er overlege i radiologi. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. PATRICIA CAMPBELL Mikrobiologi og smittevern Akershus universitetssykehus og Nasjonal kompetansetjeneste for seksuelt overførbare infeksjoner Oslo universitetssykehus Patricia Campbell er overlege i mikrobiologi. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. En mann i slutten av 40-årene ble innlagt med akutt innsettende slagsymptomer. Utredningen avslørte en sykdom som ofte glemmes, men som forekommer i økende grad og er behandlingstrengende.
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