Contributions
Abstract: EP1752
Type: ePoster
Abstract Category: Therapy - disease modifying - 29 Risk management for disease modifying treatments
Background: Alemtuzumab (ALM) is a humanized monoclonal antibody approved for the treatment of patients with active relapsing-remitting multiple sclerosis (RRMS). Treatment with this agent may be accompanied by some serious complications. Following this treatment, another autoimmune disease can develop and infectious complications of varying severity can also occur. The present case report describes the development of listeria monocytogenes meningitis in a female patient following a course of ALM for multiple sclerosis.
Case report: A 28 year old female of Caucasian race with RRMS developed a fever up to 40 degrees Celsius, headache, vomiting and global weakness several days after a course of 5 infusions of ALM. At neurological exam the signs of meningeal irritation were found and lumbar puncture showed hyperproteinorrhachia (1,098 g/l), elevated cells (72 in 1 ml) and also elevated level of lactate (6,95 mmol/l). PCR DNA of listeria monocytogenes in the CSF was positive. After treatment with ampicilin and cefotaxim the further course of this complication was favourable and patient was discharged home in stabilized clinical status within 17 days.
Discussion and conclusion: Listeria monocytogenes meningitis is a bacterial infection. Its source is usually contaminated food. Patients who have received ALM may be more vulnerable to this infection due to changes in the immune system (depletion in both innate and adaptive immunity, which can facilitate the breakthrough of pre-existing clinically silent and CD8+ T-cells modulated infection with listeria monocytogenes). Thus, increased clinical alertness is essential for correct diagnosis and management of this condition. Patients should be also advised to avoid a “risky” food (like meat without heat adjustment, soft cheeses, fresh food from the market, non-pasteurised food etc.) several weeks before and after course of ALM.
Disclosure: none of the authors has anything to disclose
Abstract: EP1752
Type: ePoster
Abstract Category: Therapy - disease modifying - 29 Risk management for disease modifying treatments
Background: Alemtuzumab (ALM) is a humanized monoclonal antibody approved for the treatment of patients with active relapsing-remitting multiple sclerosis (RRMS). Treatment with this agent may be accompanied by some serious complications. Following this treatment, another autoimmune disease can develop and infectious complications of varying severity can also occur. The present case report describes the development of listeria monocytogenes meningitis in a female patient following a course of ALM for multiple sclerosis.
Case report: A 28 year old female of Caucasian race with RRMS developed a fever up to 40 degrees Celsius, headache, vomiting and global weakness several days after a course of 5 infusions of ALM. At neurological exam the signs of meningeal irritation were found and lumbar puncture showed hyperproteinorrhachia (1,098 g/l), elevated cells (72 in 1 ml) and also elevated level of lactate (6,95 mmol/l). PCR DNA of listeria monocytogenes in the CSF was positive. After treatment with ampicilin and cefotaxim the further course of this complication was favourable and patient was discharged home in stabilized clinical status within 17 days.
Discussion and conclusion: Listeria monocytogenes meningitis is a bacterial infection. Its source is usually contaminated food. Patients who have received ALM may be more vulnerable to this infection due to changes in the immune system (depletion in both innate and adaptive immunity, which can facilitate the breakthrough of pre-existing clinically silent and CD8+ T-cells modulated infection with listeria monocytogenes). Thus, increased clinical alertness is essential for correct diagnosis and management of this condition. Patients should be also advised to avoid a “risky” food (like meat without heat adjustment, soft cheeses, fresh food from the market, non-pasteurised food etc.) several weeks before and after course of ALM.
Disclosure: none of the authors has anything to disclose