Alemtuzumab
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Guillain-Barre´ syndrome (first report) in an elderly patient: case report A 73-year-old man with T-cell prolymphocytic leukaemia developed Guillain-Barr´e syndrome (GBS) during treatment with alemtuzumab [Campath]. The man received a course of IV alemtuzumab, comprising one 3mg dose, two 10mg doses and twelve 30mg doses over the course of 34 days, and presented to an emergency department 62 days after therapy completion; he had a 1-week history of numbness and tingling and a 2-day history of falls. On admission, his strength was 4/5 in all extremities, and he reported ’rubbery’ legs, and tingling sensations in his hands and feet. A reflex test revealed 2+ reflexes in his upper, and 1+ reflexes in his lower extremities. GBS was suspected. Laboratory investigations showed the following: WBC count 4.9, haemoglobin 11.6, haematocrit 33.8 and platelets 199 000. His strength rapidly decreased over the next 48 hours, starting with his legs, but involving both upper and lower extremities by day 4. Findings from electromyography and nerve conduction studies confirmed GBS with generalised motor and sensory polyneuropathy, and demyelination. CSF analysis showed a glucose level of 62 mg/dL, a protein level of 99 mg/dL, an albumin level of 48.2 mg/dL and oligoclonal bands; his blood glucose, protein and albumin levels were 100 mg/dL, 5.2 g/dL and 2.8 g/dL, respectively. The man underwent plasmapheresis and received IV immune globulin (IVIG) with improvement of upper and lower extremity strength to 2/5 and 1/5 (toe flexors), respectively. However, his condition again worsened 7 days after IVIG administration, and lower extremity strength returned to 0/5; he developed breathing difficulties and required intubation and ventilation. After another 5 days of plasmapheresis and inpatient rehabilitation, his strength improved to 2/5 and 3/5 in his lower and upper extremities, respectively. About 2 months after discharge, he had regained strength of 4/5 in all four extremities. Author comment: "We postulate that alemtuzumab like other immunosuppressive agents may predispose patients to develop GBS putatively via an autoimmune mechanism resulting from indiscriminate dysregulation of regulatory T cells or via molecular mimicry." Abbi KK, et al. Guillain-Barre syndrome after use of alemtuzumab (Campath) in a patient with T-cell prolymphocytic leukemia: a case report and review of the 803028643 literature. Leukemia Research 34: e154-6, No. 7, Jul 2010 - USA
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of GuillainBarr´e syndrome associated with alemtuzumab. The WHO ADR database contained seven reports of Guillain-Barre syndrome associated with alemtuzumab.
0114-9954/10/1312-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Reactions 31 Jul 2010 No. 1312
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