Hemophagocytic syndrome following alemtuzumab treatment for multiple sclerosis: A case report

• Published in: Multiple sclerosis and related disorders 2020-05, Vol.40, p.101973, Article 101973
• Main Authors: Romero, A., Midaglia, L., Salcedo, M.T., Viladomiu, L., Guillén, E., Bajaña, I., Escolà-Vergé, L., Tintoré, M., Montalban, X., Len, O.
• Format: Article
• Language: English
• Subjects: Adult; Adverse effects; Alemtuzumab; Alemtuzumab - adverse effects; Autoimmune disease; Corticosteroids; Hemophagocytic syndrome; Humans; Immunologic Factors - adverse effects; Lymphohistiocytosis, Hemophagocytic - chemically induced; Male; Multiple sclerosis; Multiple Sclerosis, Relapsing-Remitting - drug therapy
• ISSN: 2211-0348; 2211-0356
• DOI: 10.1016/j.msard.2020.101973

•Alemtuzumab is used for treating relapsing-remitting multiple sclerosis.•Alemtuzumab produces a prolonged lymphocyte depletion with deferred t cell reconstitution.•This late repopulation of t cells favors the risk of autoimmune diseases.•Hemophagocytic syndrome could be one of this adverse events.•Hemophagocytic syndrome can lead to a severe progressive multi-organ failure. : Alemtuzumab is a monoclonal antibody targeting CD-52, used for treating relapsing-remitting multiple sclerosis (RRMS). : We present a case of a 44-year-old male with RRMS who was admitted due to fever and jaundice after starting treatment with alemtuzumab 12 months ago. : He was diagnosed with hemophagocytic syndrome (HS). Liver biopsy revealed images of hemophagocytosis in Kupffer cells of lobular sinusoid. Management consisted of treatment with corticosteroids. : HS is a severe condition marked by an excessive activation of the immune system that leads to a rapid and progressive multi-organ failure, so it is important to consider it in the differential diagnosis of a fever syndrome following the administration of alemtuzumab.