Author Of 1 Presentation
P0342 - Immune reconstitution inflammatory syndrome in a patient treated with alemtuzumab a few years earlier (ID 1627)
Alemtuzumab is a monoclonal antibody directed against antigen CD52 on cells of the immune system. It is used in the treatment of highly active multiple sclerosis. Immune reconstitution inflammatory syndrome (IRIS) develops due to reconstruction of cellular immunity and inflammation in the central nervous system, in most cases after progressive multifocal leukoencephalopathy (PML). Sometimes IRIS can also occur in the absence of PML.
IRIS in a patient treated with alemtuzumab eight years earlier is described. A series of images of MR of the brain will be presented.
A 38-year-old male patient was admitted because of dysphasia, bulbar syndrome and severe agitation. In 2011 and 2012 he was treated with alemtuzumab because of highly active MS. After 7 years of remission, in 2019 he had a relapse, and in February 2020 he developed severe neurological exacerbation.
MRI of the brain showed multiple big confluencing lesions hyperintensive in T2 weighted images, in the white matter, both supra- and infratentorially, associated with mass effect and contrast enhancement. The patient was treated with prolonged steroids therapy and plasma exchange. JCV-DNA was negative in the CSF. On series of control MRI there was gradual regression of lesions. Neurological state of the patient improved.
IRIS can be a complication of alemtuzumab treatment and arise from the restoration of the previously suppressed immune response, in the absence of active infection i.e. PML.