Internal Medicine Department, Hôpital Bicêtre, APHP, Université Paris Saclay, Le Kremlin-Bicêtre, France.
AP-HP, Intensive Care Unit, Hôpital Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
Br J Haematol. 2024 Apr;204(4):1459-1463. doi: 10.1111/bjh.19263. Epub 2023 Dec 19.
Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare and life-threatening disease that may result from drug exposure. We report a case of iTTP occurring in a 39-year-old patient, 45 months following introduction of the anti-CD52 lymphoid cell depleting monoclonal antibody alemtuzumab, to treat a relapsing-remitting multiple sclerosis. Treatment consisted in plasma exchange, corticosteroids and caplacizumab, allowing clinical remission 3 months after the diagnosis, attested by the absence of thrombocytopenia and recovery of ADAMTS-13 activity. As other autoimmune disorders, iTTP may occur following alemtuzumab. This diagnosis should be suspected in patients with features of thrombotic microangiopathy following this treatment.
免疫介导性血栓性血小板减少性紫癜（iTTP）是一种罕见且危及生命的疾病，可能由药物暴露引起。我们报告了一例发生在 39 岁患者中的 iTTP 病例，该患者在接受抗 CD52 淋巴细胞耗竭单克隆抗体阿仑单抗治疗复发性缓解型多发性硬化症 45 个月后出现 iTTP。治疗包括血浆置换、皮质类固醇和卡普西珠单抗，诊断后 3 个月临床缓解，血小板减少和 ADAMTS-13 活性恢复证明了这一点。与其他自身免疫性疾病一样，iTTP 可能在阿仑单抗治疗后发生。在这种治疗后出现血栓性微血管病特征的患者中，应怀疑这种诊断。
