Gynecological adverse effects of natalizumab administration: Case report and review of the literature

Background: Natalizumab is administered for the treatment of relapsing-remitting multiple sclerosis (RR-MS) with high disease activity.Natalizumab therapy has been associated with adverse effects, such as progressive multifocal leukoencephalopathy, liver damage, nasopharyngitis, urinary tract infection, urticaria, cephalgia, dizziness, fatigue, nausea, fever, rigidity, anxiety and gastroenteritis.

Objective: To describe a case of a woman with RR-MS who developed recurrent vaginitis on natalizumab administration.

Methods: Case report and review of the literature.

Results: The case of a 26-year-old Caucasian woman with RR-MS, who presented with recurrent vaginitis since the initiation of treatment with natalizumab, is reported. The patient had a 4-year history of RR-MS; monotherapy with natalizumab (inj. 300 mg/month) came after one year after the initial diagnosis. Since then, she had a history of persistent gynecological infections; the repeated vaginal cultures revealed a variety of underlying pathogens. The patient underwent numerous treatments with local and systematic antibiotics as well as antifungal agents. After the initiation of probiotics and local hygiene measures, recurrences resolved and the patient remains recurrence-free at one-year follow-up.

Conclusions: Recurrent vaginitis should be taken into account as a possible adverse effect causing discomfort during long-term natalizumab treatment. Simple measures, such as probiotic administration and meticulous local hygiene, can provide adequate relief for such patients.