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Fatal bilateral intracerebral hemorrhage following treatment with alemtuzumab for multiple sclerosis

  • I. SinicinaEmail author
  • J. Schlegel
  • K. Bise
  • F. Liesche
  • H. Pankratz
Case reports
  • 29 Downloads

Abstract

Background

Alemtuzumab is approved for treating multiple sclerosis. It can, however, cause intracerebral hemorrhage (ICH) mediated by an immune thrombocytopenia. So far, only one fatal case of ICH following alemtuzumab treatment in a patient with a normal platelet count has been reported. A connection to alemtuzumab could, however, not be verified because no autopsy was performed on the deceased.

Objective

The main objective of this article is to report the case of a patient with normal platelet count, who suffered a fatal bilateral ICH shortly after treatment with alemtuzumab was initiated. Histological signs of increased vascular permeability were found.

Conclusion

Under consideration of the clinical cause and the neuropathological findings, it is suggested that a causal connection exists between the alemtuzumab treatment and the ICH, which was possibly mediated by vascular damage.

Keywords

Encephalomyelitis disseminata Anti-CD52 antibody Neuropathology Autoimmunity Coagulopathy 

Tödliche bilaterale intrazerebrale Blutungen nach Therapie mit Alemtuzumab bei Multipler Sklerose

Zusammenfassung

Hintergrund

Alemtuzumab wurde vor einigen Jahren für die Behandlung der multiplen Sklerose zugelassen. Es kann jedoch eine Immunthrombozytopenie mit der möglichen Folge einer intrazerebralen Blutung verursachen. In der Literatur gibt es nur einen Bericht über eine intrazerebrale Blutung bei einer Patientin mit einer im Normbereich liegenden Thrombozytenzahl. Da aber in diesem Fall keine Obduktion durchgeführt wurde, ist eine kausale Verbindung zwischen Alemtuzumab und der Blutung nicht belegbar.

Ziel

Das Hauptziel dieses Beitrags ist es, über den Fall einer Patientin mit im Normbereich liegender Thrombozytenzahl zu berichten, die infolge einer bilateralen intrazerebralen Blutung nur wenige Tage nach dem Beginn der Alemtuzumab-Infusion verstarb. Histologisch fanden sich Zeichen einer erhöhten vaskulären Permeabilität.

Schlussfolgerung

Aufgrund des klinischen Verlaufs und des Ergebnisses der neuropathologischen Untersuchung liegt eine kausale Verbindung zwischen der Therapie mit Alemtuzumab und dem Tod der Patientin nahe.

Schlüsselwörter

Encephalomyelitis disseminata Anti-CD52-Antikörper Neuropathologie Autoimmunität Koagulopathie 

Notes

Compliance with ethical guidelines

Conflict of interest

I. Sinicina, J. Schlegel, K. Bise, F. Liesche and H. Pankratz declare that they have no competing interests.

All procedures on human tissue reported in this article were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The procedures were carried out in compliance with the guidelines of the Central Ethics Committee of the German Medical Association.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • I. Sinicina
    • 1
    Email author
  • J. Schlegel
    • 2
  • K. Bise
    • 1
  • F. Liesche
    • 2
  • H. Pankratz
    • 1
  1. 1.Department of Legal MedicineLudwig Maximilians UniversityMunichGermany
  2. 2.Department of NeuropathologyTU MunichMunichGermany

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