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Serum sickness (Like Reaction) in a patient treated with alemtuzumab for multiple sclerosis: A case report.
Mult Scler Relat Disord. 2018 Nov; 26:52-54.MS

Abstract

BACKGROUND

Alemtuzumab is a monoclonal antibody approved for relapsing-remitting multiple sclerosis (RRMS). The only report of Serum Sickness (SS) in a MS patient occurred during treatment with natalizumab. Non-protein drugs, such as some antibiotics, may induce "SS-like" reactions (SSLR), whose clinical and laboratory features may partially overlap with the traditional SS.

OBJECTIVE

To report a case of SS/SSLR in a RRMS patient treated with alemtuzumab.

CASE REPORT

A 42-year-old-woman with RRMS developed SS/SSLR in the first week after the first alemtuzumab treatment. Concomitant medications included trimethoprim-sulfamethoxazole at low dose. Intravenous methylprednisolone therapy led to clinical resolution and normalization of serum inflammatory markers.

CONCLUSION

SS/SSLR should be considered in patients treated with alemtuzumab developing delayed fever, rash and arthralgia and differentiated with Infusion Associated Reactions (IARs) and infections.

Authors+Show Affiliations

Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy. Electronic address: lapucci.caterina@alice.it.Department of Hematology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy.Division of Infectious Diseases, University of Genova (DISSAL) and Ospedale Policlinico San Martino, Genoa, Italy.Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy.Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy.Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy.Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30223229

Citation

Lapucci, C, et al. "Serum Sickness (Like Reaction) in a Patient Treated With Alemtuzumab for Multiple Sclerosis: a Case Report." Multiple Sclerosis and Related Disorders, vol. 26, 2018, pp. 52-54.
Lapucci C, Gualandi F, Mikulska M, et al. Serum sickness (Like Reaction) in a patient treated with alemtuzumab for multiple sclerosis: A case report. Mult Scler Relat Disord. 2018;26:52-54.
Lapucci, C., Gualandi, F., Mikulska, M., Palmeri, S., Mancardi, G., Uccelli, A., & Laroni, A. (2018). Serum sickness (Like Reaction) in a patient treated with alemtuzumab for multiple sclerosis: A case report. Multiple Sclerosis and Related Disorders, 26, 52-54. https://doi.org/10.1016/j.msard.2018.09.006
Lapucci C, et al. Serum Sickness (Like Reaction) in a Patient Treated With Alemtuzumab for Multiple Sclerosis: a Case Report. Mult Scler Relat Disord. 2018;26:52-54. PubMed PMID: 30223229.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serum sickness (Like Reaction) in a patient treated with alemtuzumab for multiple sclerosis: A case report. AU - Lapucci,C, AU - Gualandi,F, AU - Mikulska,M, AU - Palmeri,S, AU - Mancardi,G, AU - Uccelli,A, AU - Laroni,A, Y1 - 2018/09/11/ PY - 2018/03/08/received PY - 2018/08/04/revised PY - 2018/09/10/accepted PY - 2018/9/18/pubmed PY - 2019/3/1/medline PY - 2018/9/18/entrez KW - Alemtuzumab KW - Arthralgia KW - Monoclonal antibodies KW - Multiple Sclerosis KW - Serum sickness KW - Serum sickness like reaction SP - 52 EP - 54 JF - Multiple sclerosis and related disorders JO - Mult Scler Relat Disord VL - 26 N2 - BACKGROUND: Alemtuzumab is a monoclonal antibody approved for relapsing-remitting multiple sclerosis (RRMS). The only report of Serum Sickness (SS) in a MS patient occurred during treatment with natalizumab. Non-protein drugs, such as some antibiotics, may induce "SS-like" reactions (SSLR), whose clinical and laboratory features may partially overlap with the traditional SS. OBJECTIVE: To report a case of SS/SSLR in a RRMS patient treated with alemtuzumab. CASE REPORT: A 42-year-old-woman with RRMS developed SS/SSLR in the first week after the first alemtuzumab treatment. Concomitant medications included trimethoprim-sulfamethoxazole at low dose. Intravenous methylprednisolone therapy led to clinical resolution and normalization of serum inflammatory markers. CONCLUSION: SS/SSLR should be considered in patients treated with alemtuzumab developing delayed fever, rash and arthralgia and differentiated with Infusion Associated Reactions (IARs) and infections. SN - 2211-0356 UR - https://www.unboundmedicine.com/medline/citation/30223229/Serum_sickness__Like_Reaction__in_a_patient_treated_with_alemtuzumab_for_multiple_sclerosis:_A_case_report_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2211-0348(18)30318-3 DB - PRIME DP - Unbound Medicine ER -