Alemtuzumab-induced lung injury in multiple sclerosis: Learning from adversity in three patients

Mult Scler Relat Disord. 2020 Jan:37:101450. doi: 10.1016/j.msard.2019.101450. Epub 2019 Oct 15.

Abstract

Background: Respiratory alemtuzumab-related adverse events are clinically heterogeneous and include respiratory infections, infusion-related dyspnea, hypoxia and secondary autoimmune disorders.

Case report: Here we report three cases of drug-induced lung disease following treatment with alemtuzumab in multiple sclerosis patients. First case was diagnosed as a non-specified intestitial pneumonitis associated with organizing pneumonia with subacute onset, second case was an acute respiratory distress syndrome with onset during second cycle, third case was a diffuse acute alveolar hemorrhage during first cycle infusion. All patients developed acute respiratory failure, reversible after steroid therapy.

Conclusions: Clinicians should be aware to early recognize acute and subacute respiratory adverse events for a promptly management. In these patients re-treatment is challenging.

Keywords: Acute respiratory distress syndrome; Diffuse alveolar haemorrhage; Interstitial pneumonitis; Personalized medicine; Pulmonary toxicity.

Publication types

  • Case Reports

MeSH terms

  • Acute Lung Injury / chemically induced*
  • Adolescent
  • Adult
  • Alemtuzumab / adverse effects*
  • Female
  • Humans
  • Immunologic Factors / adverse effects*
  • Lung Diseases, Interstitial / chemically induced*
  • Male
  • Multiple Sclerosis, Relapsing-Remitting / drug therapy*
  • Respiratory Distress Syndrome / chemically induced*

Substances

  • Immunologic Factors
  • Alemtuzumab