Natalizumab
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Natalizumab Eosinophilic pneumonia: case report A 39-year-old woman developed eosinophilic pneumonia during treatment with natalizumab for multiple sclerosis. The woman, who had been undergoing treatment for relapsing-remitting multiple sclerosis (RRMS) in the neurology department of a hospital, was referred to the division of respiratory with a 3 months history of cough. She was diagnosed with multiple sclerosis (MS) 9 years prior. Previously, she had received interferon-β-1b, which was discontinued due to eosinophilic pneumonia (EP). Seven years prior, she received second-line treatment with fingolimod. Five months prior, she started receiving natalizumab [route and dosage not stated] for relapsing-remitting MS. She was a nonsmoker and occasional alcohol drinker, and had a history of bronchial asthma. On presentation, her vital signs and physical examination were normal. Symptoms like difficulty breathing, fever, wheezing, night sweats and weight loss were not observed. An arterial blood gas analysis was within normal range. Chest X-ray showed patchy consolidation in the left lower and bilateral upper lung. Chest CT scan demonstrated bilateral patchy consolidation and ground-glass opacity. Laboratory tests revealed an increase in the levels of WBC, serum IgE, eosinophils and surfactant protein D. An elevation of tumor markers, anti-neutrophil cytoplasmic antibody, serum β-D-glucan or sialylated carbohydrate antigen KL-6 was not observed. The pulmonary functional test was normal. Normal results of pulmonary function test and arterial blood gas test were indicative of mild inflammation. Bronchoalveolar lavage (BAL) of the right upper lobe was performed. BAL fluid culture revealed no growth of any fungi, bacteria or acid-fast bacillus. Cell fraction of the BAL fluid revealed eosinophilia with macrophages of 61%, eosinophils of 35% and lymphocytes of 4%. Chest CT also demonstrated EP pattern. Other causes of the EP were excluded. Chest X-ray and blood analysis prior to the initiation of natalizumab showed no abnormalities. Due to the possible natalizumab-induced EP, the woman’s natalizumab treatment was stopped. Six weeks after the discontinuation of natalizumab, an improvement in pulmonary infiltrates and peripheral blood eosinophilia was observed. Hence, she was diagnosed with EP probably attributed to natalizumab. Thereafter, she was treated with methylprednisolone and fingolimod for MS. Author comment: "[W]e report a case of eosinophilic pneumonia (EP) associated with natalizumab, as a third-line treatment for [multiple sclerosis]". Yasuda Y, et al. Eosinophilic pneumonia associated with natalizumab in a patient with multiple sclerosis: A case report and literature review. Therapeutics and Clinical Risk Management 15: 1283-1289, 1 Nov 2019. Available from: URL: 803436536 http://doi.org/10.2147/TCRM.S225832 - Japan
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Reactions 30 Nov 2019 No. 1781
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