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CC BY 4.0 · Arq Neuropsiquiatr 2024; 82(S 01): S1-S52
DOI: 10.1055/s-0044-1789424
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Exploring the relationship between ibrutinib therapy and neuromyelitis optica spectrum disorders: a case report

Ana Carolina Mourão Passos
1   Instituto de Educação Médica, Rio de Janeiro RJ, Brazil.
,
Antônia Quarti de Andrade
1   Instituto de Educação Médica, Rio de Janeiro RJ, Brazil.
,
Isabella de Oliveira Santana
1   Instituto de Educação Médica, Rio de Janeiro RJ, Brazil.
,
Gutemberg Augusto Cruz dos Santos
2   Universidade Federal Fluminense, Niterói RJ, Brazil.
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    Address for correspondence: Gutemberg Augusto Cruz dos Santos (email: gutemberg.c.santos@gmail.com).

    Abstract

    Case Presentation: We herein present the case of a 58-year-old female patient diagnosed with CLL in 2021, who had been undergoing ibrutinib therapy and, in May 2023, experienced paresthesia and dysesthesia in her lower limbs, accompanied by sensory disturbance. Furthermore, muscle weakness was observed in her lower limbs and right upper limb, leading to difficulties in mobility and urinary retention. Subsequently, she was admitted to the hospital in July 2023 for comprehensive examinations, including laboratory tests, infectious screenings, autoimmune assessments, imaging studies, cerebrospinal fluid (CSF) analysis, serological tests, and blood cultures. She was diagnosed with longitudinal transverse myelitis (TM) and commenced pulse therapy with corticosteroids, exhibiting partial improvement before being discharged for further outpatient investigation. Presently, she exhibits paraparesis with indications of pyramidal release. In January 2024, her serum tested positive for anti-aquaporin 4 antibodies at a titer of 1/10, confirming the diagnosis of neuromyelitis optica spectrum disorders (NMOSD), leading to the initiation of rituximab treatment.

    Discussion: An autoimmune disease that primarily affects the optic nerves and the spinal cord, NMOSD is characterized by recurrent attacks of inflammation in the optic nerves and the spinal cord. Ibrutinib is a medication used in the treatment of certain types of cancer, acting through the inhibition of Bruton tyrosine kinase (BTK), which plays a key role in B-cell signaling. By inhibiting BTK, ibrutinib reduces the production of certain immune cells. Therefore, it is important to recognize that ibrutinib may have effects on the immune system.

    Conclusion: Ibrutinib, like any medication affecting the immune system, can influence the development or progression of NMOSD. There is no conclusive evidence establishing a direct relationship between its use and the development of the disease. Therefore, if a patient experiences symptoms suggestive of NMOSD, it is essential to recognize the risk and perform appropriate tests.


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    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    02 October 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/)

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