Natalizumab
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First report of bruising: case report A 34-year-old woman developed bruising after monthly treatment with natalizumab for relapsing-remitting multiple sclerosis. The woman, who was diagnosed with multiple sclerosis in April 2001, developed two small bruises on the front of her right thigh a few hours after her first natalizumab infusion (300mg) on 4 September 2007. The bruising resolved after 3–4 days; however, 11 days after the natalizumab infusion bruising developed on the external side of her left calf. A clinical evaluation including test for collagen diseases and coagulation, blood and biochemical testing of platelet activation, thyroid hormones and liver enzymes showed no abnormalities. Following a second natalizumab infusion 1 month later, two small bruises developed on her left calf after 10–11 days. These bruises resolved over the next 2 weeks. Natalizumab was continued for three more months. No further bruising was observed and no other adverse effects were reported. Author comment: "According to the criteria of Karsh and Lasagna . . . bruising on the legs in our patient could be characterized as a conditional side effect following the first and second natalizumab infusions". Gatzonis S, et al. Bruising following natalizumab infusion for relapsing-remitting multiple sclerosis: A case report. Journal of Medical Case Reports 3: Jan 2009. Available from: URL: http://dx.doi.org/10.4076/1752-1947-3-8955 803013509 Greece
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of bruising associated with natalizumab. The WHO ADR database contained 41 reports of contusion associated with natalizumab.
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Reactions 8 May 2010 No. 1300
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