Ravulizumab
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Disseminated Neisseria gonorrhoeae infection: case report A 24-year-old man developed disseminated Neisseria gonorrhoeae infection during treatment with ravulizumab for paroxysmal nocturnal hemoglobinuria (PNH). The man presented due to acute onset of fever (up to 41.2°C) along with sore throat, rhinorrhoea, severe headaches and mild exertional dyspnoea for 3 days. He also reported of left ankle and right knee arthralgia. Three days later, he developed maculopapular rash and petechiae on his left palm, which later progressed to his trunk. At the age of 18 years, he was diagnosed with PNH, for which he had been receiving ravulizumab [dosage and route not stated] for 3 years. At the time of ravulizumab, he received meningococcal-vaccine-groups-A-C-Y-W-135 polysaccharide [meningococcal ACYW-135 vaccine] to prevent meningococcal infection. Physical examination revealed neck stiffness with no Kernig’s sign or Brudzinski’s sign. Tender target lesion-like papules were observed on bilateral soles and the left palm. Blood tests revealed anaemia (haemoglobin of 10.7 g/dL) with normal WBC count. His CRP had elevated to 12.9 mg/dL. Due to the concerns of meningococcal infection, he was transferred to an isolation room. CSF analysis revealed normal lactate dehydrogenase and glucose levels. Blood culture obtained on admission was detected positive for Gramnegative cocci on hospital day 2, which was confirmed as Neisseria gonorrhoeae using matrix-assisted laser desorption/ionisation time of flight system [time to reaction onset not stated]. The man was treated with ceftriaxone on admission. After Neisseria gonorrhoeae isolation, he was started on azithromycin. After ruling out CNS infection, ceftriaxone dose was reduced. He reported of having unprotected sex 1 week prior to the symptom onset. One day after the administration of ceftriaxone, his fever resolved. After 7 days course of ceftriaxone, he was discharged with improvement of arthralgias and skin rash. His HIV tests were negative. During follow-up at the outpatient clinic, he was vaccinated with pneumococcal-13 valent CRM197 vaccine conjugate [13-valent pneumococcal conjugate vaccine], Hib-vaccine [Haemophilusinfluenzae-type-b-vaccine] and hepatitis-A-vaccine. Yu Z-Y, et al. Disseminated gonococcal infection in a patient with paroxysmal nocturnal hemoglobinuria having received ravulizumab and meningococcal vaccine. Journal of 803501052 Microbiology, Immunology and Infection 53: 660-662, No. 4, Aug 2020. Available from: URL: http://doi.org/10.1016/j.jmii.2020.06.013
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Reactions 12 Sep 2020 No. 1821
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