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Diffuse alveolar hemorrhage during alemtuzumab infusion in a patient with multiple sclerosis: a case report

BACKGROUND: Diffuse alveolar bleeding is a potentially life-threatening condition that can be induced by several drugs. Whereas fatal cases have been reported in patients treated for other indications, no report have so far been published in a patient with multiple sclerosis treated with alemtuzumab...

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Autores principales: Myro, Aija Zuleron, Bjerke, Gisle, Zarnovicky, Svetozar, Holmøy, Trygve
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245888/
https://www.ncbi.nlm.nih.gov/pubmed/30454022
http://dx.doi.org/10.1186/s40360-018-0267-5
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author Myro, Aija Zuleron
Bjerke, Gisle
Zarnovicky, Svetozar
Holmøy, Trygve
author_facet Myro, Aija Zuleron
Bjerke, Gisle
Zarnovicky, Svetozar
Holmøy, Trygve
author_sort Myro, Aija Zuleron
collection PubMed
description BACKGROUND: Diffuse alveolar bleeding is a potentially life-threatening condition that can be induced by several drugs. Whereas fatal cases have been reported in patients treated for other indications, no report have so far been published in a patient with multiple sclerosis treated with alemtuzumab. CASE PRESENTATION: We report a case of alemtuzumab-induced diffuse alveolar bleeding in a 29 year old woman with relapsing remitting multiple sclerosis. The patient developed acute shortness of breath, chest pain on inspiration and haemoptysis following the second infusion of alemtuzumab during the first treatment cycle. Computed tomography showed bilateral alveolar opacities. Bronchoscopy and broncho-alveolar lavage showed persistently bloody return with no evidence of infection. The symptoms resolved completely without treatment and control computed tomography performed one week later showed total resolution of pulmonary infiltrates. CONCLUSION: This is the first published report of diffuse alveolar bleeding in a patient with multiple sclerosis treated with alemtuzumab. Four similar cases in patients treated for multiple sclerosis and several fatal cases in patients treated for other conditions are registered at the World Health Organization database of suspected adverse events (VIgiBase©), underscoring that this is a serious and possibly under-recognized complication of alemtuzumab which can also occur in the treatment of multiple sclerosis. The clinician should consider the possibility of diffuse pulmonary haemorrhage in patients with sudden onset of respiratory distress and haemoptysis following administration of alemtuzumab for multiple sclerosis.
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spelling pubmed-62458882018-11-26 Diffuse alveolar hemorrhage during alemtuzumab infusion in a patient with multiple sclerosis: a case report Myro, Aija Zuleron Bjerke, Gisle Zarnovicky, Svetozar Holmøy, Trygve BMC Pharmacol Toxicol Case Report BACKGROUND: Diffuse alveolar bleeding is a potentially life-threatening condition that can be induced by several drugs. Whereas fatal cases have been reported in patients treated for other indications, no report have so far been published in a patient with multiple sclerosis treated with alemtuzumab. CASE PRESENTATION: We report a case of alemtuzumab-induced diffuse alveolar bleeding in a 29 year old woman with relapsing remitting multiple sclerosis. The patient developed acute shortness of breath, chest pain on inspiration and haemoptysis following the second infusion of alemtuzumab during the first treatment cycle. Computed tomography showed bilateral alveolar opacities. Bronchoscopy and broncho-alveolar lavage showed persistently bloody return with no evidence of infection. The symptoms resolved completely without treatment and control computed tomography performed one week later showed total resolution of pulmonary infiltrates. CONCLUSION: This is the first published report of diffuse alveolar bleeding in a patient with multiple sclerosis treated with alemtuzumab. Four similar cases in patients treated for multiple sclerosis and several fatal cases in patients treated for other conditions are registered at the World Health Organization database of suspected adverse events (VIgiBase©), underscoring that this is a serious and possibly under-recognized complication of alemtuzumab which can also occur in the treatment of multiple sclerosis. The clinician should consider the possibility of diffuse pulmonary haemorrhage in patients with sudden onset of respiratory distress and haemoptysis following administration of alemtuzumab for multiple sclerosis. BioMed Central 2018-11-19 /pmc/articles/PMC6245888/ /pubmed/30454022 http://dx.doi.org/10.1186/s40360-018-0267-5 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Myro, Aija Zuleron
Bjerke, Gisle
Zarnovicky, Svetozar
Holmøy, Trygve
Diffuse alveolar hemorrhage during alemtuzumab infusion in a patient with multiple sclerosis: a case report
title Diffuse alveolar hemorrhage during alemtuzumab infusion in a patient with multiple sclerosis: a case report
title_full Diffuse alveolar hemorrhage during alemtuzumab infusion in a patient with multiple sclerosis: a case report
title_fullStr Diffuse alveolar hemorrhage during alemtuzumab infusion in a patient with multiple sclerosis: a case report
title_full_unstemmed Diffuse alveolar hemorrhage during alemtuzumab infusion in a patient with multiple sclerosis: a case report
title_short Diffuse alveolar hemorrhage during alemtuzumab infusion in a patient with multiple sclerosis: a case report
title_sort diffuse alveolar hemorrhage during alemtuzumab infusion in a patient with multiple sclerosis: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245888/
https://www.ncbi.nlm.nih.gov/pubmed/30454022
http://dx.doi.org/10.1186/s40360-018-0267-5
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AT zarnovickysvetozar diffusealveolarhemorrhageduringalemtuzumabinfusioninapatientwithmultiplesclerosisacasereport
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