Diffuse Alveolar Haemorrhage: A Fatal Complication After Alemtuzumab Induction Therapy in Renal Transplantation

Tahir, Wasif; Hakeem, A.; Baker, Richard J.; Ahmad, Niaz

doi:10.1016/j.transproceed.2014.10.037

Cited by 13 publications

(11 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is therefore conceivable that the uptake of haemosiderin by macrophages could be perturbed shortly after alemtuzumab infusion. The two previously published case reports of alemtuzumab-associated alveolar haemorrhage do not mention whether this finding was present [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Alveolar haemorrhage can be induced by several drugs including monoclonal antibodies [ 4 , 11 ]. Two reports on patients with Alport’s syndrome who received alemtuzumab as a part of immunosuppressive induction protocols during kidney transplantation have been published [ 9 , 10 ]. Like our patient both these patients received premedication with steroids before administration of alemtuzumab, and in one BAL fluid was also positive for polymorphs [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Two reports on patients with Alport’s syndrome who received alemtuzumab as a part of immunosuppressive induction protocols during kidney transplantation have been published [ 9 , 10 ]. Like our patient both these patients received premedication with steroids before administration of alemtuzumab, and in one BAL fluid was also positive for polymorphs [ 10 ]. In contrast to our patient who received 12 mg alemtuzumab on two consecutive days, both these patients received 30 mg alemtuzumab as one single subcutaneous or intravenous injection at the transplantation day, and both developed acute respiratory failure and haemoptysis the second day after alemtuzumab administration.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike our patient who recovered without any treatment after cessation of alemtuzumab, both developed severe respiratory failure and required mechanical ventilation, and were treated with steroids, plasma exchange and dialysis due to acute tubular necrosis. One of these patients died due to worsening respiratory function and failing graft function [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Alport’s syndrome possibly predisposes to alveolar haemorrhage due to altered collagen structure [ 10 ]. Our patient has an asymptomatic bicuspid aortic valve which can be associated with connective tissue disorders [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Diffuse alveolar hemorrhage during alemtuzumab infusion in a patient with multiple sclerosis: a case report

Myro

Bjerke

Zarnovicky

et al. 2018

BMC Pharmacol Toxicol

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%