Haberli Nicholas, Coban Hamza, Padam Charanpreet, Montezuma-Rusca Jairo M, Creed Marina A, Imitola Jaime
Division of Multiple Sclerosis and Neuroimmunology, Comprehensive MS Center, University of Connecticut School of Medicine.
Division of Infectious Diseases, Department of Medicine, University of Connecticut School of Medicine; Department of Pediatrics, University of Connecticut School of Medicine.
Mult Scler Relat Disord. 2021 Feb;48:102731. doi: 10.1016/j.msard.2020.102731. Epub 2021 Jan 3.
Ocrelizumab is a humanized monoclonal anti-CD20 antibody approved for treatment of relapsing-remitting and primary progressive multiple sclerosis (MS). Rare parasitic infections have been reported in patients with lymphoproliferative disorders using rituximab, a chimeric anti-CD20 antibody used off-label for the treatment of MS. Here, we report a patient with MS on ocrelizumab with B-cell depletion who developed severe Babesia microti (B. microti) infection with neutropenia, hemolytic anemia, and thrombocytopenia. He recovered after prompt diagnosis and treatment. This case represents the first published occurrence of babesiosis in a patient with MS on ocrelizumab. It also adds to the accumulating evidence from databases of emergent severe or relapsing B. microti infection in patients receiving anti-CD20 antibodies. This presentation stresses the diagnostic vigilance required by MS neurologists in endemic areas to identify cases of babesiosis in patients on anti-CD20 therapy and to better counsel these individuals on their risks of B. microti infection.
奥瑞珠单抗是一种人源化单克隆抗CD20抗体，已被批准用于治疗复发缓解型和原发进展型多发性硬化症（MS）。使用利妥昔单抗（一种用于MS治疗的非标签嵌合抗CD20抗体）的淋巴增殖性疾病患者中曾报告过罕见的寄生虫感染。在此，我们报告1例接受奥瑞珠单抗治疗且B细胞耗竭的MS患者，该患者发生了严重的微小巴贝斯虫（B. microti）感染，并伴有中性粒细胞减少、溶血性贫血和血小板减少。经及时诊断和治疗后，他康复了。该病例是首例关于接受奥瑞珠单抗治疗的MS患者发生巴贝斯虫病的报道。它也进一步补充了来自数据库的越来越多的证据，这些证据表明接受抗CD20抗体治疗的患者出现了严重或复发性微小巴贝斯虫感染。本报告强调了MS神经科医生在流行地区需要保持诊断警惕性，以便识别接受抗CD20治疗患者中的巴贝斯虫病病例，并更好地向这些个体提供微小巴贝斯虫感染风险的咨询。
