Home
|
Inbox
|
Search
|
View Abstract
Severe Legionella Pneumonia Complicating Alemtuzumab Therapy for Relapsing Multiple Sclerosis
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A5293 - Severe Legionella Pneumonia Complicating Alemtuzumab Therapy for Relapsing Multiple Sclerosis
Author Block: E. Villarreal, N. Jentzen, J. Zein; Respiratory Institute, Cleveland Clinic, Cleveland, OH, United States.
Severe Legionella Pneumonia Complicating Alemtuzumab Therapy for Relapsing Remitting Multiple Sclerosis.
Introduction:
Alemtuzumab is a humanized monoclonal antibody against CD52, an antigen found on the surface of normal and malignant lymphocytes. Serious, including fatal bacterial, viral, fungal and protozoan infections can occur, as a result of severe CD4 and CD8 lymphopenia. We report a case of severe Legionella pneumonia complicating Alemtuzumab therapy for Relapsing Remitting Multiple Sclerosis (RRMS).
Case Description:
A 35-year old man with past medical history of RRMS on Alemtuzumab was admitted to the medical intensive care unit (MICU) with acute hypoxemic respiratory failure and septic shock requiring therapy with norepinephrine, vasopressin and epinephrine. He was initially treated with Vancomycin, Meropenem and Azithromycin for severe community acquired pneumonia. Additionally, Amphotericin B was added empirically for suspected disseminated histoplasmosis. He received mechanical ventilatory support with 6mL/kg as per ARDSNet guidelines. His hospital stay was complicated with acute renal failure, which subsequently resolved. Amphotericin therapy was complicated with anaphylactoid reactions that improved subsequently once it was switched to Posaconazole. Unfortunately, Posaconazole therapy was complicated with increased liver function tests and was subsequently changed to Isavuconazole. Bronchoscopy was performed upon admission. A bronchoalveolar lavage (BAL) was obtained. BAL specimen grew Legionella pneumophila. Urine Legionella antigen was positive as well. Due to the severity of illness and severe immunosuppressive state, Levofloxacin was added to azithromycin for double coverage for a total of 3-weeks. During his 14 day stay in the MICU, his condition gradually improved and was transferred to inpatient rehabilitation service to help manage his severe critical illness polyneuropathy.
Discussion:
Biologics are popular nowadays and are frequently used in a myriad of illnesses. They frequently interfere with the immune system and result in severe life-threatening infections. Appropriate vaccination and counseling regarding side effects are of extreme importance as we acquire more experience with their use.
Author Block: E. Villarreal, N. Jentzen, J. Zein; Respiratory Institute, Cleveland Clinic, Cleveland, OH, United States.
Severe Legionella Pneumonia Complicating Alemtuzumab Therapy for Relapsing Remitting Multiple Sclerosis.
Introduction:
Alemtuzumab is a humanized monoclonal antibody against CD52, an antigen found on the surface of normal and malignant lymphocytes. Serious, including fatal bacterial, viral, fungal and protozoan infections can occur, as a result of severe CD4 and CD8 lymphopenia. We report a case of severe Legionella pneumonia complicating Alemtuzumab therapy for Relapsing Remitting Multiple Sclerosis (RRMS).
Case Description:
A 35-year old man with past medical history of RRMS on Alemtuzumab was admitted to the medical intensive care unit (MICU) with acute hypoxemic respiratory failure and septic shock requiring therapy with norepinephrine, vasopressin and epinephrine. He was initially treated with Vancomycin, Meropenem and Azithromycin for severe community acquired pneumonia. Additionally, Amphotericin B was added empirically for suspected disseminated histoplasmosis. He received mechanical ventilatory support with 6mL/kg as per ARDSNet guidelines. His hospital stay was complicated with acute renal failure, which subsequently resolved. Amphotericin therapy was complicated with anaphylactoid reactions that improved subsequently once it was switched to Posaconazole. Unfortunately, Posaconazole therapy was complicated with increased liver function tests and was subsequently changed to Isavuconazole. Bronchoscopy was performed upon admission. A bronchoalveolar lavage (BAL) was obtained. BAL specimen grew Legionella pneumophila. Urine Legionella antigen was positive as well. Due to the severity of illness and severe immunosuppressive state, Levofloxacin was added to azithromycin for double coverage for a total of 3-weeks. During his 14 day stay in the MICU, his condition gradually improved and was transferred to inpatient rehabilitation service to help manage his severe critical illness polyneuropathy.
Discussion:
Biologics are popular nowadays and are frequently used in a myriad of illnesses. They frequently interfere with the immune system and result in severe life-threatening infections. Appropriate vaccination and counseling regarding side effects are of extreme importance as we acquire more experience with their use.
|
Home
|
Inbox
|
Search
|