From the Departments of Neurology (S.R., A.S., A.M.) and Neuroradiology (H.U.), University Medical Center Freiburg; Institute of Neuropathology (L.S., W.B., I.M.), University Medical Center Goettingen; Institute of Neuropathology, Medical Faculty (P.S., M.P.), and BIOSS Centre for Biological Signalling Studies (M.P.), University of Freiburg, Germany.
Neurology. 2018 Jul 24;91(4):e359-e363. doi: 10.1212/WNL.0000000000005854. Epub 2018 Jun 22.
To report on 2 women with multiple sclerosis (MS) who developed severe neurologic deterioration and a drug reaction with eosinophilia and systemic symptoms (DRESS) after treatment with 2 and 4 subcutaneous injections of daclizumab, respectively.
This report includes clinical, MRI, and histopathologic data.
Daclizumab is a humanized monoclonal antibody that binds the interleukin-2 receptor. It was approved for the treatment of relapsing MS. DRESS is an immunologic reaction to various medications that is characterized by eosinophilia as well as cutaneous and visceral manifestations. Following daclizumab treatment, both patients showed fulminant neurologic deterioration along with blood eosinophilia and skin changes, and both fulfilled the clinical criteria for the diagnosis of DRESS. They presented with multiple gadolinium-enhancing supra- and infratentorial lesions, with lesions in the basal ganglia, mesencephalon, and cerebellum. Brain biopsies revealed a pronounced inflammatory infiltrate including numerous eosinophils infiltrating demyelinating lesions, a feature that is atypical for MS but compatible with DRESS. In addition, numerous plasma cells and changes reminiscent of vasculitis were evident.
Neurologic deterioration and DRESS occurred as severe adverse drug effects of daclizumab treatment. Early diagnosis and treatment of DRESS are essential because it is associated with complications such as new autoimmune diseases and liver failure, and may even be lethal. Because of its potential serious side effects, daclizumab was recently suspended for use in the European Union.
报告 2 例多发性硬化症（MS）患者，分别在接受 2 次和 4 次皮下注射达利珠单抗治疗后，出现严重神经功能恶化和伴有嗜酸性粒细胞增多和全身症状的药物反应（DRESS）。
本报告包括临床、MRI 和组织病理学数据。
达利珠单抗是一种与人白细胞介素-2 受体结合的人源化单克隆抗体。它被批准用于治疗复发型多发性硬化症。DRESS 是一种对各种药物的免疫反应，其特征是嗜酸性粒细胞增多以及皮肤和内脏表现。在接受达利珠单抗治疗后，两名患者均出现暴发性神经功能恶化，伴有血嗜酸性粒细胞增多和皮肤改变，且均符合 DRESS 的临床诊断标准。他们表现为多发钆增强幕上和幕下病变，基底节、中脑和小脑也有病变。脑活检显示明显的炎症浸润，包括浸润脱髓鞘病变的大量嗜酸性粒细胞，这一特征不符合 MS，但与 DRESS 相符。此外，还可见大量浆细胞和类似于血管炎的改变。
神经功能恶化和 DRESS 是达利珠单抗治疗的严重药物不良反应。早期诊断和治疗 DRESS 至关重要，因为它与新的自身免疫性疾病和肝衰竭等并发症有关，甚至可能致命。由于其潜在的严重副作用，达利珠单抗最近在欧盟被暂停使用。
