Alemtuzumab-associated diffuse alveolar damage – a case report

Abstract

Background Identifying causes of alemtuzumab induced respiratory symptoms in Multiple Sclerosis (MS) patients is crucial. Case presentation We report a case of diffuse alveolar damage (DAD) in a patient with MS after the first course of alemtuzumab treatment. A 42-year-old female developed progressive non-productive cough and exertional dyspnea 2 months after alemtuzumab treatment. DAD was diagnosed histopathologically by lung biopsy. The patient recovered completely, alemtuzumab was not continued. Conclusions Our case highlights another pathomechanism for non-infective lung-disorders in alemtuzumab treated MS patients. DAD is a potential, albeit rare side effect of alemtuzumab, broadening the spectrum of non-infective lung disorders that should be considered in the diagnostic work-up.

Assessing causality by means of the Naranjo scale in a paediatric patient with life threatening respiratory failure after alemtuzumab administration: a case report

“…There are previous reports on similar reactions after alemtuzumab administration (point 1). Six articles describe pulmonary reactions [ 12 – 17 ] including eight patients between 16 and 54 years of age. In these patients, alemtuzumab was prescribed for relapsing remitting MS ( n = 6) or induction after kidney transplantation ( n = 2).…”

“…All patients experienced dyspnoea, fatigue and coughing, but only three patients required ICU admission for respiratory insufficiency [ 15 – 17 ] of which one patient died [ 16 ]. Symptoms started between 24 h after the first administration [ 15 ] to up to 2 months after the first five-day cycle [ 12 ]. In our patient, respiratory failure occurred 7 h after the second dose and quickly worsened (point 2).…”