RSS-Feed abonnieren
PDF herunterladen
DOI: 10.1055/s-0044-1789402
Seronegative de novo myasthenia gravis induced by alemtuzumab: a case report
Authors
Address for correspondence: Vanessa Lauanna Lima Silva (email: vanessalauanna@gmail.com).
Abstract
Case Presentation: A 39-year-old female patient with relapsing-remitting multiple sclerosis (RRMS) was elected for alemtuzumab treatment. She had a medical history of diabetes, hypertension, obesity, and NASH. Alemtuzumab was indicated after treatment failure with natalizumab, evidenced by the presence of multiple new enhancing lesions. The formal protocol of 12 mg for 5 days with 1 g of methylprednisolone a day for the first 3 days, and, concomitantly acyclovir, diphenhydramine and acetaminophen, was performed. The first course was in May 2019 and the second course, in June 2020. Approximately one year after the last course, the patient presented with fluctuating muscle fatigue and ptosis, with worsening of the symptoms towards the end of the day. During the investigation for neuromuscular junction disease, anti-AChR and anti-MuSK were negative, and electromyography revealed single-fiber changes with pathological electro-decrement. A thoracic CT scan ruled out the presence of thymoma. Neoplastic screening with full body CT was unremarkable. After diagnosing myasthenia gravis (MG), treatment was started with pyridostigmine and prednisone, with improvement of the symptoms. The patient is currently undergoing treatment with rituximab to manage both autoimmune pathologies.
Discussion: Alemtuzumab, a monoclonal antibody that targets CD52 on lymphocytes, results in the depletion of B and T cells. While it is a highly-effective therapy approved for the treatment of RRMS, alemtuzumab is linked to adverse events, such as opportunistic infections and autoimmune reactions, with thyroid disorders being the most prevalent autoimmune adverse event observed. Notably, myasthenic syndromes represent an exceedingly rare and unexpected adverse effect of this medication, despite its autoimmune mechanism of action.
Final Comments: We herein report a case of a de novo seronegative MG induced by alemtuzumab in a patient with RRMS. To date, there is little data available on this topic. To our knowledge, the present is the second published report on MG following alemtuzumab therapy.
Die Autoren geben an, dass kein Interessenkonflikt besteht.
Publikationsverlauf
Artikel online veröffentlicht:
02. Oktober 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil