Alemtuzumab
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Diffuse pulmonary haemorrhage: case report A 25-year-old woman developed diffuse pulmonary haemorrhage (DPH) during treatment with alemtuzumab for relapse of multiple sclerosis (MS). The woman was admitted in September 2018 to a pulmonary clinic from the emergency ward of a hospital for the acute onset of chest pain, cough, non massive haemoptysis and dyspnoea at rest. These symptoms started after the fourth dose of IV alemtuzumab 12 mg/day, administered for a relapse of MS. Alemtuzumab was administered for the first time on 13 September 2018, followed by other 3 doses, respectively on 14, 16 and 17 September 2018. After the third dose, mild erythema emerged in the trunk and upper limbs, which required treatment with chlorphenamine. At the occurrence of pulmonary symptoms, the woman discontinued alemtuzumab treatment. She was a non-smoker, unemployed and had a medical history of epilepsy (diagnosed in May 2015) secondary to the presence of a cavernous angioma of the left frontal lobe, which had been treated in 2015 with local embolisation, and then followed by a regular therapy with levetiracetam. In January 2017, she had been diagnosed multiple sclerosis. At admission, her chest CT revealed diffuse and bilateral ground glass pulmonary opacities. During hospitalisation, the routine laboratory examinations revealed a mild decrease in serum haemoglobin along with a mild increase in the C-reactive protein. The diffusing capacity for carbon monoxide performed on day 4 after hospitalisation revealed a normal value when corrected for actual hemoglobin level. Based on the laboratory investigations, she was diagnosed with DPH. She was left untreated, and during the hospitalisation, no additional episodes of haemoptysis occurred. After 9 days, she was discharged. After 1 month, she returned to the outpatient clinic for a post-discharge visit and underwent a test to evaluate the diffusion capacity for carbon monoxide, which showed a normal value. On 20 October 2018, a new CT scan of the chest showed complete resolution of the pulmonary opacities. According to Naranjo causality assessment scale, the causal relationship between use of alemtuzumab and DPH was scored as "probable". Cipolla G, et al. A case of lung injury resembling diffuse pulmonary hemorrhage after the first administration of alemtuzumab in a patient with multiple sclerosis. Role of the 803502824 HRCT. Monaldi Archives for Chest Disease 90: 474-478, No. 3, 2020. Available from: URL: http://doi.org/10.4081/MONALDI.2020.1352
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Reactions 26 Sep 2020 No. 1823
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