Department of Dermatology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China.
Department of Graduate Studies, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.
Front Immunol. 2024 Aug 1;15:1409480. doi: 10.3389/fimmu.2024.1409480. eCollection 2024.
Efgartigimod (Efgartigimod alpha fcab, Vyvgart™) is a pioneering neonatal Fc receptor (FcRn) antagonist for the treatment of severe autoimmune diseases mediated by pathogenic immunoglobulin G (IgG) autoantibodies, including myasthenia gravis (MG). It is a well-tolerated drug with minor side effects, such as headache and upper respiratory (lung) and urinary tract infections. Here, we present a case of Kaposi's varicelliform eruption (KVE) and herpetic conjunctivitis related to efgartigimod in a 60-year-old patient with ocular MG (OMG).
A 60-year-old Chinese male suffered from acetylcholine receptor antibody positive (AChR Ab+) OMG for 8 years. During this period, he underwent first-line treatment with systemic corticosteroids, cyclosporine, cyclophosphamide, and so on, but had poor symptom improvement. On the recommendation of his attending neurologist, he received one cycle of intravenous efgartigimod (10mg/kg, once weekly for 4 weeks). The patient experienced fever, widespread painful blisters, and edema on the face on the third day after his last intravenous infusion. The patient also complained of increased secretions and a foreign body sensation in both eyes. Laboratory tests confirmed infection with herpes simplex virus (HSV). A diagnosis of efgartigimod-associated KVE and herpetic conjunctivitis was made. After intravenous administration (5mg/kg, 3 times a day, every 8 hours) for 10 days, the patient was cured without residual complications.
This case is the first report of a patient with KVE and herpetic conjunctivitis related to efgartigimod in PubMed. This is rare and unusual. Clinicians should be alert to the rare symptoms related to efgartigimod.
依非格司亭（依非格司亭 alpha fcab，Vyvgart™）是一种开创性的新生儿 Fc 受体（FcRn）拮抗剂，用于治疗致病性免疫球蛋白 G（IgG）自身抗体介导的严重自身免疫性疾病，包括重症肌无力（MG）。它是一种耐受性良好的药物，副作用较小，如头痛、上呼吸道（肺部）和尿路感染。在这里，我们报告了一例与依非格司亭相关的卡波西水痘样疹（KVE）和疱疹性结膜炎，患者为 60 岁男性，患有眼肌型 MG（OMG）。
一名 60 岁的中国男性患有乙酰胆碱受体抗体阳性（AChR Ab+）OMG 8 年。在此期间，他接受了一线治疗，包括全身皮质类固醇、环孢素、环磷酰胺等，但症状改善不佳。根据他的主治神经科医生的建议，他接受了一个周期的依非格司亭静脉输注（10mg/kg，每周一次，共 4 周）。患者在最后一次静脉输注后第 3 天出现发热、广泛疼痛性水疱和面部水肿。患者还主诉双眼分泌物增多和异物感。实验室检查证实感染单纯疱疹病毒（HSV）。诊断为依非格司亭相关 KVE 和疱疹性结膜炎。静脉输注（5mg/kg，每日 3 次，每 8 小时 1 次）治疗 10 天后，患者痊愈，无残留并发症。
这是 PubMed 上首例报告的与依非格司亭相关的 KVE 和疱疹性结膜炎病例。这种情况罕见且不常见。临床医生应警惕与依非格司亭相关的罕见症状。
