Abstract Details

Title Cytomegalovirus (CMV) Primoinfection in a patient with Multiple Sclerosis treated with Alemtuzumab

Topic Multiple Sclerosis

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-027

Objective We report one patient with Multiple Sclerosis (MS) who develops CMV primoinfection after third cycle of alemtuzumab.

Background Alemtuzumab is an anti-CD52 monoclonal antibody approved for the treatment of MS. It produces rapid depletion of T and B lymphocytes, which could predispose to opportunistic infections.

Design/Methods Review of patient’s history, complementary tests, treatment, outcome and bibliography available.

Results 36 year-old woman, with no relevant medical history, diagnosed with MS in 2005. She was treated with interferon-beta-1a between 2006 and 2008, changed to glatiramer-acetate due to inefficacy. In 2009, she started alemtuzumab because of clinical and radiological disease activity. She received a 5 doses cycle in 2009 and 3 doses cycle in 2010 (12 mg/day each dose). In 2017, she had new symptoms and 3 new gadolinium-enhancing lesions in brain MRI. Because of that, she received a third cycle of alemtuzumab (3 doses). CMV IgG was negative prior to treatment. She received prophylaxis with acyclovir and cotrimoxazole since the first day of treatment. 10 days later, she presented with asthenia and persistent fever despite having received antibiotic because of urinary tract infection. Chest X-ray, blood test and lumbar puncture showed no abnormalities (apart from grade 2 lymphopenia that resolved in 5 days). 15 days later, blood tests revealed mononucleosis-like syndrome, positive CMV IgM and CMV viral DNA PCR (665 UI/ml). Slight liver function abnormality was also found. Abdominal echography was normal. The patient recovered completely (negative CMV PCR within a month), so we decided not to administer valganciclovir.

Conclusions In patients who develop fever the first month after alemtuzumab treatment, especially if they also have liver function abnormality or mononucleosis-like syndrome, CMV infection must be considered (in which case it will be necessary to assess the change of aciclovir by valganciclovir). We have only found 3 similar cases, none of them with spontaneous recovery.

Authors/Disclosures
Clara Aguirre Hernandez PRESENTER	Clara Aguirre Hernandez has nothing to disclose.
Virginia Meca Lallana	Virginia Meca Lallana has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file

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