Eosinophilic Fasciitis Occurring under Treatment with Natalizumab for Multiple Sclerosis

Abstract

Background: Eosinophilic fasciitis is a rare sclerosing syndrome with a poorly understood etiology. Objective: We report a case of eosinophilic fasciitis in a 40-year-old man undergoing treatment with natalizumab for multiple sclerosis. Natalizumab is a selective adhesion molecule inhibitor that prevents interaction of leukocytes with endothelial cells. Peripheral blood eosinophilia has been described under treatment with natalizumab, but we herein report the first case to our knowledge of eosinophilic fasciitis as a possible complication of this medication.Contexte: La fasciite à éosinophiles est un syndrome sclérosant rare, dont les causes sont mal connues. Objectif: Sera exposé ici un cas de fasciite à éosinophiles chez un homme de 40 ans, traité par le natalizumab, pour la sclérose en plaques. Le natalizumab est un inhibiteur sélectif des molécules d'adhésion, qui empêche les interactions entre les leucocytes et les cellules endothéliales. Il a déjà été fait mention d'éosinophilie sanguine périphérique en cours de traitement par le natalizumab, mais ¡I s'agit, à notre connaissance, du premier exposé de cas de fasciite à éosinophiles, décrit comme une complication possible de l'utilisation de ce médicament.

Natalizumab induced blood eosinophilia: A retrospective pharmacovigilance cohort study and review of the literature

“…PubMed database was searched twice by (CF, RH, LD) using the search terms "eosinophilic/eosinophilia natalizumab" and "eosinophilic/eosinophilia Tysabri" (date of last PubMed search 29.10.2020). Hereby 9 articles (Abbas et al, 2011;Florek et al, 2010;Curto et al, 2016;Yasuda et al, 2019;Bujold et al, 2014;André et al, 2010;Rocher et al, 2010;Mihalova et al, 2015;Beales, 2019) dealing with blood eosinophilia with and without clinical symptoms during natalizumab treatment were identified. We compared the data of those studies to our own data and analyzed all reported cases of asymptomatic and symptomatic eosinophilia in NTZ treated patients.…”

“…Reviewing the scientific literature leads to identification of 4 additional case reports of natalizumab treated RRMS patients with symptomatic eosinophilia (Curto et al, 2016;Yasuda et al, 2019;Bujold et al, 2014;André et al, 2010) and 3 cases with asymptomatic marked eosinophilia with cell counts >1 G/l (Abbas et al, 2011). In our single center cohort we found 1 case of symptomatic eosinophilia, 6 cases of asymptomatic marked eosinophilia and 37 cases of mild eosinophilia (which all remained asymptomatic) of in total 115 NTZ treated RRMS patients with at least one eosinophil count since July 2016.…”

“…So far, only two case reports of eosinophilic pneumonia and a single case report of each eosinophilic dermatitis and eosinophilic fasciitis during NTZ treatment have been described. (Curto et al, 2016;Yasuda et al, 2019;Bujold et al, 2014;André et al, 2010).…”

Eosinophilic fasciitis induced by natalizumab in a patient affected by multiple sclerosis

“…In the latter report Shulman disease did not relapse after subsequent infusion of natalizumab. 4 In our case the onset of fasciitis after the drug administration and the rapid recurrence after a Did the reaction reappear when a placebo was given? −1 +1 0 0…”

Monoclonal antibody therapies for the treatment of relapsing-remitting multiple sclerosis: differentiating mechanisms and clinical outcomes

“…The development of PML in one patient in SENTINEL and a second patient in the corresponding extension study prompted discontinuation of the trial approximately 1 month early [Rudick et al 2006]. No increased risk of lymphoma, malignant melanoma or hypereosinophilia was reported in these studies [Abbas et al 2011; Bujold et al 2014; Mullen et al 2008]. No increase in infection among patients receiving natalizumab, compared with placebo, was found [Polman et al 2006; Rudick et al 2006], but postmarketing studies identified a slight excess of herpes virus infections [Fine et al 2013; Holmen et al 2011] with rare cases of fatal herpes encephalitis [Biogen Idec, 2013; Kwiatkowski et al 2012] and meningitis [Biogen Idec, 2013; Shenoy et al 2011; Valenzuela et al 2014].…”