在使用阿仑单抗治疗多发性硬化症期间同时出现早期严重自身免疫性溶血性贫血和蛋白尿。
Simultaneous early-onset severe autoimmune hemolytic anemia and albuminuria during alemtuzumab treatment for multiple sclerosis.
机构信息
MS Center, Neurologic Clinic, SS. Annunziata Hospital, Chieti, Italy/Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy.
MS Center, Neurologic Clinic, SS. Annunziata Hospital, Chieti, Italy.
出版信息
Mult Scler. 2018 May;24(6):813-815. doi: 10.1177/1352458517743093. Epub 2018 Jan 23.
BACKGROUND
Alemtuzumab, approved for multiple sclerosis (MS), can cause secondary autoimmune adverse events including thyroid disorders, immune thrombocytopenia (ITP), and glomerular nephropathies. Non-ITP autoimmune cytopenias are rarely reported.
OBJECTIVE
To report a case of autoimmune hemolytic anemia (AIHA) and nephropathy in a MS patient treated with alemtuzumab.
CASE REPORT
A 34-year-old man with MS developed albuminuria and AIHA after the first and only alemtuzumab treatment, with positive Coombs' direct and indirect tests and IgG autoantibodies. Both AIHA and nephropathy resolved 1 month after treatment with steroids and intravenous immunoglobulins.
CONCLUSION
Our report adds to literature on AIHA and nephropathy after alemtuzumab treatment and suggests to add Coombs' tests to the screening panel required for alemtuzumab treatment.
背景
阿仑单抗已被批准用于多发性硬化症（MS）的治疗，但其可导致继发性自身免疫不良事件，包括甲状腺疾病、免疫性血小板减少症（ITP）和肾小球肾病。非 ITP 自身免疫性血细胞减少症很少见。
目的
报告一例接受阿仑单抗治疗的 MS 患者发生自身免疫性溶血性贫血（AIHA）和肾病。
病例报告
一名 34 岁男性，患有 MS，在接受第一次也是唯一一次阿仑单抗治疗后出现蛋白尿和 AIHA，直接和间接 Coombs 试验及 IgG 自身抗体均为阳性。在接受类固醇和静脉注射免疫球蛋白治疗 1 个月后，AIHA 和肾病均得到缓解。
结论
本报告补充了阿仑单抗治疗后发生 AIHA 和肾病的文献，并建议在阿仑单抗治疗所需的筛查方案中增加 Coombs 试验。
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