Contributions
Abstract: EP1729
Type: ePoster
Abstract Category: Therapy - disease modifying - 29 Risk management for disease modifying treatments
A 42 year old Caucasian female died from Listeriosis a week following Alemtuzumab administration, one month after discontinuing dimethyl fumarate.
This is the first mortality of a complication to which patients appear particularly vulnerable days/weeks post-administration.
Multiple Sclerosis was diagnosed in 2014. Relapse in March 2015 lead to dimethyl fumarate initiation in July 2015.
Further relapses arose in August 2015 and April 2016. Dimethyl Fumarate was discontinued in July 2016. Expanded Disability Severity Scale score was 2.5. In August 2016 Alemtuzumab 12mg iv was administered for five days with 1gram Methylprednisolone for the initial 3 days.
At day 6 post-completion, a 3 day history of diarrhoea, vomiting and malaise was reported and rapid deterioration supervened. Paramedics found the patient comatose (GCS 7; E4, V2, M1) with severe tachypnoea (60 breaths/minute), high-grade pyrexia of 40C, tachycardic and hypertensive. She was intubated on scene.
CT head revealed reduced grey-white differentiation, diffuse cerebral swelling, bilateral temporal horn distension and cisternal effacement consistent with severe meningoencephalitis. Laboratory studies demonstrated a grossly elevated C reactive protein in the absence of a peripheral leucocytosis.
Eight hours after admission her pupils became asymmetrically fixed. External ventricular drainage decompressed intracranial pressure >30cmCSF; the fluid was clear and colourless, yielding only 5 white cells and 279 red cells, protein .33g/l and a raised glucose gradient of 2.8mmol/l in CSF vs. 8.1mmol/l in serum.
Therapy included Ceftriaxone 2g b.d., Aciclovir 700mg t.d.s. and Amoxicillin 2g four hourly.
CSF PCR yielded a positive result for Listeria monocytogenes. Despite resolution of pyrexia and improving inflammatory indices a diagnosis of brain death was recorded at 60 hours following admission. Cultures of blood and CSF later supported the diagnosis of listeriosis.
There was considerable overlap with typical post-infusion symptoms therefore high surveillance and low threshold for empirical or possible prophylactic co-trimoxazole therapy is advocated.
Disclosure:
Canham L.J.W., No disclosures relevant to this presentation, has received educational support from Sanofi Genzyme, Biogen Idec, TEVA, Roche and Novartis
Manara A.: Nothing to disclose.
Fawcett J. :Nothing to disclose.
Rolinski M.:Nothing to disclose.
Mortimer A.: Nothing to disclose.
Inglis K.E.A :No disclosures relevant to this presentation, has received educational support from Sanofi Genzyme, Biogen Idec, TEVA, Roche and Novartis
Cottrell D.A. No disclosures relevant to this presentation,has received educational support from Sanofi Genzyme, Biogen Idec, TEVA, Roche and Novartis We are grateful to Sanofi Genzyme for their assistance with referencing and fact checking.
Abstract: EP1729
Type: ePoster
Abstract Category: Therapy - disease modifying - 29 Risk management for disease modifying treatments
A 42 year old Caucasian female died from Listeriosis a week following Alemtuzumab administration, one month after discontinuing dimethyl fumarate.
This is the first mortality of a complication to which patients appear particularly vulnerable days/weeks post-administration.
Multiple Sclerosis was diagnosed in 2014. Relapse in March 2015 lead to dimethyl fumarate initiation in July 2015.
Further relapses arose in August 2015 and April 2016. Dimethyl Fumarate was discontinued in July 2016. Expanded Disability Severity Scale score was 2.5. In August 2016 Alemtuzumab 12mg iv was administered for five days with 1gram Methylprednisolone for the initial 3 days.
At day 6 post-completion, a 3 day history of diarrhoea, vomiting and malaise was reported and rapid deterioration supervened. Paramedics found the patient comatose (GCS 7; E4, V2, M1) with severe tachypnoea (60 breaths/minute), high-grade pyrexia of 40C, tachycardic and hypertensive. She was intubated on scene.
CT head revealed reduced grey-white differentiation, diffuse cerebral swelling, bilateral temporal horn distension and cisternal effacement consistent with severe meningoencephalitis. Laboratory studies demonstrated a grossly elevated C reactive protein in the absence of a peripheral leucocytosis.
Eight hours after admission her pupils became asymmetrically fixed. External ventricular drainage decompressed intracranial pressure >30cmCSF; the fluid was clear and colourless, yielding only 5 white cells and 279 red cells, protein .33g/l and a raised glucose gradient of 2.8mmol/l in CSF vs. 8.1mmol/l in serum.
Therapy included Ceftriaxone 2g b.d., Aciclovir 700mg t.d.s. and Amoxicillin 2g four hourly.
CSF PCR yielded a positive result for Listeria monocytogenes. Despite resolution of pyrexia and improving inflammatory indices a diagnosis of brain death was recorded at 60 hours following admission. Cultures of blood and CSF later supported the diagnosis of listeriosis.
There was considerable overlap with typical post-infusion symptoms therefore high surveillance and low threshold for empirical or possible prophylactic co-trimoxazole therapy is advocated.
Disclosure:
Canham L.J.W., No disclosures relevant to this presentation, has received educational support from Sanofi Genzyme, Biogen Idec, TEVA, Roche and Novartis
Manara A.: Nothing to disclose.
Fawcett J. :Nothing to disclose.
Rolinski M.:Nothing to disclose.
Mortimer A.: Nothing to disclose.
Inglis K.E.A :No disclosures relevant to this presentation, has received educational support from Sanofi Genzyme, Biogen Idec, TEVA, Roche and Novartis
Cottrell D.A. No disclosures relevant to this presentation,has received educational support from Sanofi Genzyme, Biogen Idec, TEVA, Roche and Novartis We are grateful to Sanofi Genzyme for their assistance with referencing and fact checking.