Contributions
Abstract: EP1656
Type: ePoster
Abstract Category: Therapy - disease modifying - 26 Immunomodulation/Immunosuppression
Objective: We present a case of Legionnaires' disease in a patient on dimethyl fumarate (DMF) with lymphopenia.
Background: Lymphopenia is a well-established consequence of DMF therapy. A myriad of infections have been reported in lymphopenic patients on DMF including respiratory, urinary tract, herpes virus, and gastrointestinal infections. Special attention has been paid to the risk of progressive multifocal leukoencephalopathy in patients on DMF with very low or rapidly dropping lymphocyte counts. To our knowledge there are no reported cases of Legionnaires' disease in a patient on DMF.
Discussion: The patient was diagnosed with relapsing-remitting multiple sclerosis (RRMS) in September 2013 after an episode of right arm numbness in in September 2012 followed by right leg weakness in May of 2013 and MRI consistent with MS. He began on DMF as disease-modifying therapy in October 2013. His absolute lymphocyte count (ALC) dropped to 600 in July 2014 and reached a nadir of 400 in February 2014. Potential change in therapy was discussed however ALC stabilized at 500 in December 2015 and April 2016. He reported no infections during this time.
In August of 2016 the patient developed rigors with fever to 102 Fahrenheit. He had intractable cough, myalgias, and malaise. Chest x-ray revealed bilateral patchy infiltrates concerning for pneumonia. He received an intramuscular injection of ceftriaxone with little response after which he was started on an oral course of levofloxacin and began to improve. Urine antigen test for Legionella was positive. Investigation revealed no report of any outbreak of Legionnaires' disease at the patient's home, work or fitness center. He reported no atypical exposures. He fully recovered with completion of the course of levofloxacin.
Conclusion: We present this case of Legionnaires' disease in a patient with RRMS on DMF therapy to add to the body of literature on infections encountered in lymphopenic patients on this medication.
Disclosure:
Dr. Rachel Brandstadter: nothing to disclose
Dr. Ilana Katz Sand: nothing to disclose
Abstract: EP1656
Type: ePoster
Abstract Category: Therapy - disease modifying - 26 Immunomodulation/Immunosuppression
Objective: We present a case of Legionnaires' disease in a patient on dimethyl fumarate (DMF) with lymphopenia.
Background: Lymphopenia is a well-established consequence of DMF therapy. A myriad of infections have been reported in lymphopenic patients on DMF including respiratory, urinary tract, herpes virus, and gastrointestinal infections. Special attention has been paid to the risk of progressive multifocal leukoencephalopathy in patients on DMF with very low or rapidly dropping lymphocyte counts. To our knowledge there are no reported cases of Legionnaires' disease in a patient on DMF.
Discussion: The patient was diagnosed with relapsing-remitting multiple sclerosis (RRMS) in September 2013 after an episode of right arm numbness in in September 2012 followed by right leg weakness in May of 2013 and MRI consistent with MS. He began on DMF as disease-modifying therapy in October 2013. His absolute lymphocyte count (ALC) dropped to 600 in July 2014 and reached a nadir of 400 in February 2014. Potential change in therapy was discussed however ALC stabilized at 500 in December 2015 and April 2016. He reported no infections during this time.
In August of 2016 the patient developed rigors with fever to 102 Fahrenheit. He had intractable cough, myalgias, and malaise. Chest x-ray revealed bilateral patchy infiltrates concerning for pneumonia. He received an intramuscular injection of ceftriaxone with little response after which he was started on an oral course of levofloxacin and began to improve. Urine antigen test for Legionella was positive. Investigation revealed no report of any outbreak of Legionnaires' disease at the patient's home, work or fitness center. He reported no atypical exposures. He fully recovered with completion of the course of levofloxacin.
Conclusion: We present this case of Legionnaires' disease in a patient with RRMS on DMF therapy to add to the body of literature on infections encountered in lymphopenic patients on this medication.
Disclosure:
Dr. Rachel Brandstadter: nothing to disclose
Dr. Ilana Katz Sand: nothing to disclose