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Erschienen in: Neurological Sciences 10/2021

31.07.2021 | COVID-19 | COVID-19 Zur Zeit gratis

Chickenpox and asymptomatic COVID-19 after first cycle of alemtuzumab for multiple sclerosis

verfasst von: Mario Habek

Erschienen in: Neurological Sciences | Ausgabe 10/2021

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Excerpt

A 28-year-old woman, kindergarten teacher, developed double vision on left gaze in May 2018. Neurological examination revealed right internuclear ophthalmoplegia. Brain and spinal cord MRI showed 15 T2 and FLAIR hyperintense periventricular, juxtacortical, and infratentorial lesions and 2 lesions in the cervical spinal cord; 2 brainstem lesions showed Gadolinium enhancement. Cerebrospinal fluid was positive for oligoclonal IgG bands, and she was diagnosed with relapsing remitting multiple sclerosis (RRMS). The patient fully recovered after pulse methylprednisolone treatment. In July 2018, she developed incomplete transverse myelitis with Th12 sensory level when she again received pulse methylprednisolone treatment. MRI performed in February 2019 showed 5 new supratentorial lesions. Because of the highly active RRMS and pregnancy planning, it was decided to start treatment with alemtuzumab. During the work-up before starting alemtuzumab, varicella zoster virus (VZV) IgG came back negative, and vaccination against VZV was recommended before starting treatment. However, it took three doses of live attenuated varicella virus (OKA strain) vaccine (Varilrix®) until a titer of VZV IgG was satisfactory for treatment start (0.87) (< 0.60 negative; 0.60—< 0.90 intermediate; ≥ 0.90 positive; enzyme linked fluorescent assay). From March 9 to 10, 2020, the patient received the first course of alemtuzumab. She developed a rash from day 2 through 5, which was symptomatically treated. The patient did not take any other concomitant treatments. Lymphocytes ranged from 0.32 in May 2020 to 0.88 × 109 in October 2020. After an outbreak of chickenpox in the kindergarten, the patient developed small, itchy blisters on the arms and back on November 20, 2020 (Fig. 1). Therapy with acyclovir, 400 mg 5 times a day through 7 days, was initiated, and she completely recovered. At the same time, her husband was diagnosed with COVID-19, and she spent 14 more days in self isolation. She never developed any symptoms characteristic for COVID-19, and she returned to work. Oropharyngeal swab during her husband’s quarantine was not performed. In December 2020, serology for SARS-CoV-2 revealed the titer of antibody to spike protein titer of 102 U/ml (positive value ≥ 0.8 U/ml, Elecsys® anti-SARSCoV-2 S assay, Roche Diagnostics Int., Rotkreuz, Switzerland).In March 2021, VZV IgG titer was 3.89, and the patient received second cycle of alemtuzumab.
Literatur
1.
Zurück zum Zitat Willis MD, Harding KE, Pickersgill TP, Wardle M, Pearson OR, Scolding NJ, Smee J, Robertson NP (2016) Alemtuzumab for multiple sclerosis: long term follow-up in a multi-centre cohort. Mult Scler 22:1215–1223CrossRef Willis MD, Harding KE, Pickersgill TP, Wardle M, Pearson OR, Scolding NJ, Smee J, Robertson NP (2016) Alemtuzumab for multiple sclerosis: long term follow-up in a multi-centre cohort. Mult Scler 22:1215–1223CrossRef
2.
Zurück zum Zitat Winkelmann A, Loebermann M, Reisinger EC, Hartung HP, Zettl UK (2016) Disease-modifying therapies and infectious risks in multiple sclerosis. Nat Rev Neurol 12:217–233CrossRef Winkelmann A, Loebermann M, Reisinger EC, Hartung HP, Zettl UK (2016) Disease-modifying therapies and infectious risks in multiple sclerosis. Nat Rev Neurol 12:217–233CrossRef
3.
Zurück zum Zitat Giovannoni G, Hawkes C, Lechner-Scott J, Levy M, Waubant E, Gold J (2020) The COVID-19 pandemic and the use of MS disease-modifying therapies. Mult Scler Relat Disord 39:102073CrossRef Giovannoni G, Hawkes C, Lechner-Scott J, Levy M, Waubant E, Gold J (2020) The COVID-19 pandemic and the use of MS disease-modifying therapies. Mult Scler Relat Disord 39:102073CrossRef
4.
Zurück zum Zitat Carandini T, Pietroboni AM, Sacchi L, De Riz MA, Pozzato M, Arighi A, Fumagalli GG, Martinelli Boneschi F, Galimberti D, Scarpini E (2020) Alemtuzumab in multiple sclerosis during the COVID-19 pandemic: a mild uncomplicated infection despite intense immunosuppression. Mult Scler 26:1268–1269CrossRef Carandini T, Pietroboni AM, Sacchi L, De Riz MA, Pozzato M, Arighi A, Fumagalli GG, Martinelli Boneschi F, Galimberti D, Scarpini E (2020) Alemtuzumab in multiple sclerosis during the COVID-19 pandemic: a mild uncomplicated infection despite intense immunosuppression. Mult Scler 26:1268–1269CrossRef
5.
Zurück zum Zitat McCarthy CL, Tuohy O, Compston DA, Kumararatne DS, Coles AJ, Jones JL (2013) Immune competence after alemtuzumab treatment of multiple sclerosis. Neurology 81:872–876CrossRef McCarthy CL, Tuohy O, Compston DA, Kumararatne DS, Coles AJ, Jones JL (2013) Immune competence after alemtuzumab treatment of multiple sclerosis. Neurology 81:872–876CrossRef
6.
Zurück zum Zitat Fernández-Díaz E, Gracia-Gil J, García-García JG, Palao M, Romero-Sánchez CM, Segura T (2020) COVID-19 and multiple sclerosis: a description of two cases on alemtuzumab. Mult Scler Relat Disord 45:102402CrossRef Fernández-Díaz E, Gracia-Gil J, García-García JG, Palao M, Romero-Sánchez CM, Segura T (2020) COVID-19 and multiple sclerosis: a description of two cases on alemtuzumab. Mult Scler Relat Disord 45:102402CrossRef
7.
Zurück zum Zitat Fiorella C, Lorna G (2020) COVID-19 in a multiple sclerosis (MS) patient treated with alemtuzumab: insight to the immune response after COVID. Mult Scler Relat Disord 46:102447CrossRef Fiorella C, Lorna G (2020) COVID-19 in a multiple sclerosis (MS) patient treated with alemtuzumab: insight to the immune response after COVID. Mult Scler Relat Disord 46:102447CrossRef
8.
Zurück zum Zitat Marin M, Marti M, Kambhampati A, Jeram SM, Seward JF (2016) Global varicella vaccine effectiveness: a meta-analysis. Pediatrics 137:e20153741CrossRef Marin M, Marti M, Kambhampati A, Jeram SM, Seward JF (2016) Global varicella vaccine effectiveness: a meta-analysis. Pediatrics 137:e20153741CrossRef
9.
Zurück zum Zitat Marzano AV, Genovese G, Fabbrocini G, Pigatto P, Monfrecola G, Piraccini BM, Veraldi S, Rubegni P, Cusini M, Caputo V, Rongioletti F, Berti E, Calzavara-Pinton P (2020) Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients. J Am Acad Dermatol 83:280–285CrossRef Marzano AV, Genovese G, Fabbrocini G, Pigatto P, Monfrecola G, Piraccini BM, Veraldi S, Rubegni P, Cusini M, Caputo V, Rongioletti F, Berti E, Calzavara-Pinton P (2020) Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients. J Am Acad Dermatol 83:280–285CrossRef
Metadaten
Titel
Chickenpox and asymptomatic COVID-19 after first cycle of alemtuzumab for multiple sclerosis
verfasst von
Mario Habek
Publikationsdatum
31.07.2021
Verlag
Springer International Publishing
Schlagwort
COVID-19
Erschienen in
Neurological Sciences / Ausgabe 10/2021
Print ISSN: 1590-1874
Elektronische ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-021-05495-6

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