Mortality from Listeria monocytogenes meningoencephalitis following escalation to alemtuzumab therapy for relapsing-remitting Multiple Sclerosis

We report the case of a patient who died from the rare complication of Listeriosis in the immediate phase following alemtuzumab administration one month after discontinuing dimethyl fumarate (DMF). There is considerable overlap with typical post-infusion symptoms therefore high surveillance and low threshold for empirical or possible prophylactic antibiotic therapy is advocated.
Source: Multiple Sclerosis and Related Disorders - Category: Neurology Source Type: research

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We report herein a case of bloodstream infection due to LM in a 25-year-old woman with MS treated with alemtuzumab. We searched the UMC/WHO Vigibase system for all reported cases of LM in patients treated with alemtuzumab and found 29 cases overall up to 21 July 2019. We also performed a literature review of MS cases with LM on alemtuzumab, in order to evaluate epidemiology, clinical characteristics, and outcome of this complication. Since the published cases (N=8) were mainly reported in recent years but more cases were found in the UMC/WHO Vigibase system (although not necessarily in patients with MS), we hypothesize tha...
Source: Infezioni in Medicina - Category: Infectious Diseases Tags: Infez Med Source Type: research
ConclusionWe describe the first probable case of fingolimod-associated Listeria monocytogenes rhombencephalitis in a patient with multiple sclerosis. Clinicians should be aware of listeriosis and implement measures for its prevention.
Source: Multiple Sclerosis and Related Disorders - Category: Neurology Source Type: research
To the Editor We read with interest the article by Ruggieri et al, who report a case of a woman with multiple sclerosis who developedListeria monocytogenes rhombencephalitis (LRE). She was immunocompetent aside from receiving dimethyl fumarate and never developed lymphopenia while receiving treatment before presentation. The authors state that the risk of severe complications, such as rhombencephalitis that is secondary toL monocytogenes, is higher among immunocompromised patients and hypothesize how dimethyl fumarate may have contributed to the development of this central nervous system infection.
Source: JAMA Neurology - Category: Neurology Source Type: research
In Reply We thank Budhram and Kim for their observations on our article. We agree with their comment regarding the role of differential diagnosis between a relapse and an acute infection of the central nervous system. This remains a crucial point in treating patients with multiple sclerosis, especially while they are receiving treatment with disease-modifying drugs. They correctly underline how an appropriate and fast treatment could reduce the neurological complications of central nervous system infections. Therefore we believe that our case report is useful in valuing the role of a deep anamnesis and emphasizes the need ...
Source: JAMA Neurology - Category: Neurology Source Type: research
We report the case of a patient who died from the rare complication of Listeriosis in the immediate phase following alemtuzumab administration one month after discontinuing dimethyl fumarate (DMF). There is considerable overlap with typical post-infusion symptoms therefore high surveillance and low threshold for empirical or possible prophylactic antibiotic therapy is advocated.
Source: Multiple Sclerosis and Related Disorders - Category: Neurology Source Type: research
Abstract The spectrum of therapeutic options for immunotherapy of multiple sclerosis is continuously broadening. After the approval of cladribine and ocrelizumab in Europe, two new drugs are now available with ocrelizumab being the first approved option for treatment of primary progressive multiple sclerosis; however, the increased use of highly effective therapies is accompanied by a rise in severe side effects. During recent months, special attention was paid to the new progressive multifocal leukoencephalopathy (PML) risk assessment in natalizumab-treated patients, cardiac side effects of fingolimod, cases...
Source: Der Nervenarzt - Category: Neurology Authors: Tags: Nervenarzt Source Type: research
We report the case of a patient who died from the rare complication of Listeriosis in the immediate phase following alemtuzumab administration one month after discontinuing dimethyl fumarate (DMF). There is considerable overlap with typical post-infusion symptoms therefore high surveillance and low threshold for empirical or possible prophylactic antibiotic therapy is advocated.
Source: Multiple Sclerosis and Related Disorders - Category: Neurology Source Type: research
Authors: Buonomo AR, Zappulo E, Viceconte G, Scotto R, Borgia G, Gentile I Abstract INTRODUCTION: Alemtuzumab is a monoclonal anti CD-52 antibody recently approved for use in relapsing-remitting multiple sclerosis(MS). Given that the targeted antigen is primarily expressed on B and T lymphocytes, the administration of this biological drug is associated with rapid but protracted peripheral lymphopenia. Areas covered: The impact on infective risk of this immune impairment is still to be fully understood. In this review, we attempt to summarize all the available literature concerning opportunistic infections occurring...
Source: Expert Opinion on Drug Safety - Category: Drugs & Pharmacology Tags: Expert Opin Drug Saf Source Type: research
We report the case of a patient who died from the rare complication of Listeriosis in the immediate phase following Alemtuzumab administration one month after discontinuing dimethyl fumarate (DMF). There is considerable overlap with typical post-infusion symptoms therefore high surveillance and low threshold for empirical or possible prophylactic antibiotic therapy is advocated.
Source: Multiple Sclerosis and Related Disorders - Category: Neurology Source Type: research
Conclusions:To our knowledge this is the third case of a Listeria meningitis after alemtuzumab treatment worldwide. Physicians and patients should be aware of this serious, but treatable complication.Disclosure: Dr. Bayas has received personal compensation for activities with Merck Serono, Biogen Idec, Novartis, and Sanofi, and Genzyme as a consultant and/or speaker. Dr. Rank has nothing to disclose. Dr. Naumann has nothing to disclose.
Source: Neurology - Category: Neurology Authors: Tags: MS and CNS Inflammatory Diseases: Treatment Efficacy, Safety and Tolerability Source Type: research
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