Ustekinumab
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Reversible cerebral vasoconstriction syndrome: case report A 50-year-old woman developed reversible cerebral vasoconstriction syndrome (RCVS) following treatment with ustekinumab for Crohn’s disease. The woman, whose medical history was notable for Crohn’s disease, presented to an emergency department with a nuchal headache for 1 week. She stated that the first onset of the recurrent, acute onset headache of the greatest intensity (9/10 on the numerical rating scale) had been 7 days prior to admission. She also reported accompanying epigastric pain. She was hospitalised. A review of her history revealed that she had been receiving SC injections of ustekinumab 90mg every 8 weeks for the previous 6 months. Cerebral CT scan revealed left frontal sulcal hyperdensities, which were also observed in a cerebral MRI, as bihemispheric signal alterations in the form of a multifocal, sulcal subarachnoid haemorrhage of the convexity. Time-of-flight angiography demonstrated segmental calibre jumps, in the form of vasospasm in several river areas. Transcranial Doppler sonography revealed increased systolic flow values in the middle cerebral artery on both sides and in the C7 segment of the arteria carotis interna. CSF analysis was unremarkable; laboratory analyses revealed no relevant acute phase reaction. Clinically and neurologically, she experienced another two acute episodes of headache during the inpatient stay. The strongest, pressing headaches lasted for hours, were nuchally localised with a holocephalic radiation, and occurred without a focal neurological deficit. A lighter, background headache persisted in between. The woman received analgesic therapy with dipyrone [metamizole] and nimodipine for the vasospasm. She was discharged after 12 days, when she became symptom-free. Her headaches and accelerated flow regressed over the following 3 months. Schmidbauer ML, et al. Drug-induced reversible cerebral vasoconstriction syndrome: Ustekinumab as possible trigger? Schmerz 34: 350-353, No. 4, Aug 2020. Available 803498297 from: URL: http://doi.org/10.1007/s00482-020-00479-5 [German; summarised from a translation]
0114-9954/20/1819-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 29 Aug 2020 No. 1819
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