Case report| Volume 22, P139-140, May 2018

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Pneumonitis secondary to alemtuzumab in a patient with multiple sclerosis – A non-infectious cause of breathlessness


      • Pneumonitis can occur following treatment with the monoclonal antibody alemtuzumab in a patient with multiple sclerosis.
      • In a patient presenting with breathlessness post alemtuzumab infusion a non-infectious cause needs to be considered.
      • Pneumonitis secondary to alemtuzumab can potentially be managed with oral steroids alone.


      The most common adverse events associated with the monoclonal antibody alemtuzumab are infusion associated reactions and secondary autoimmune disease. Respiratory complications are unusual following treatment with alemtuzumab, but can be precipitated by an infectious cause. We describe a case of a sub-acute steroid responsive non-infectious pneumonitis affecting a 51 year old woman, who presented one month after initiation of therapy for multiple sclerosis with alemtuzumab.


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        • Baker D.
        • Herrod S.S.
        • Alvarez-Gonzalez C.
        • Giovannoni G.
        • Schmierer K.
        Interpreting lymphocyte reconstitution data from the pivotal phase 3 trials of alemtuzumab.
        JAMA Neurol. 2017; 74: 961-969
        • Blasco M.R.
        • Ramos A.
        • Malo C.G.
        • Garcia-Merino A.
        Acute pneumonitis and pericarditis related to alemtuzumab therapy in relapsing-remitting multiple sclerosis.
        J. Neurol. 2017; 264: 168-169
        • Coles A.J.
        Alemtuzumab therapy for multiple sclerosis.
        Neurotherapeutics. 2013; 10: 29-33
        • Coles A.J.
        • Cohen J.A.
        • Fox E.J.
        • Giovannoni G.
        • Hartung H.P.
        • Havrdova E.
        • Schippling S.
        • Selmaj K.W.
        • Traboulsee A.
        • Compston D.A.S.
        • Margolin D.H.
        • Thangavelu K.
        • Chirieac M.C.
        • Jody D.
        • Xenopoulos P.
        • Hogan R.J.
        • Panzara M.A.
        • Arnold D.L.
        • Care II, M.S.
        • Investigators C.
        Alemtuzumab CARE-MS II 5-year follow-up: efficacy and safety findings.
        Neurology. 2017; 89: 1117-1126
        • Creelan B.
        • Ferber A.
        A fatal case of alemtuzumab-associated interstitial pneumonitis.
        Am. J. Ther. 2008; 15: 82-84
        • Hartung H.P.
        • Aktas O.
        • Boyko A.N.
        Alemtuzumab: a new therapy for active relapsing-remitting multiple sclerosis.
        Mult. Scler. 2015; 21: 22-34
        • Hu Y.
        • Turner M.J.
        • Shields J.
        • Gale M.S.
        • Hutto E.
        • Roberts B.L.
        • Siders W.M.
        • Kaplan J.M.
        Investigation of the mechanism of action of alemtuzumab in a human CD52 transgenic mouse model.
        Immunology. 2009; 128: 260-270
        • Jones J.L.
        • Thompson S.A.
        • Loh P.
        • Davies J.L.
        • Tuohy O.C.
        • Curry A.J.
        • Azzopardi L.
        • Hill-Cawthorne G.
        • Fahey M.T.
        • Compston A.
        • Coles A.J.
        Human autoimmunity after lymphocyte depletion is caused by homeostatic T-cell proliferation.
        Proc. Natl. Acad. Sci. USA. 2013; 110: 20200-20205
        • Matzinger P.
        The danger model: a renewed sense of self.
        Science. 2002; 296: 301-305
        • Purwar R.
        • Campbell J.
        • Murphy G.
        • Richards W.G.
        • Clark R.A.
        • Kupper T.S.
        Resident memory T cells (T(RM)) are abundant in human lung: diversity, function, and antigen specificity.
        PLoS One. 2011; 6: e16245
        • Sheikh-Taha M.
        • Corman L.C.
        Pulmonary Nocardia beijingensis infection associated with the use of alemtuzumab in a patient with multiple sclerosis.
        Mult. Scler. 2017; 23: 872-874
        • Tahir W.
        • Hakeem A.
        • Baker R.
        • Ahmad N.
        Diffuse Alveolar haemorrhage: a fatal complication after alemtuzumab induction therapy in renal transplantation.
        Transplant. Proc. 2015; 47: 151-154
        • Willis M.D.
        • Harding K.E.
        • Pickersgill T.P.
        • Wardle M.
        • Pearson O.R.
        • Scolding N.J.
        • Smee J.
        • Robertson N.P.
        Alemtuzumab for multiple sclerosis: long term follow-up in a multi-centre cohort.
        Mult. Scler. 2016; 22: 1215-1223
        • Yann K.
        • Jackson F.
        • Sharaf N.
        • Mihalova T.
        • Talbot P.
        • Rog D.
        • Pace A.
        Acute respiratory distress syndrome following alemtuzumab therapy for relapsing multiple sclerosis.
        Mult. Scler. Relat. Disord. 2017; 14: 1-3
        • Zhang X.
        • Tao Y.
        • Chopra M.
        • Ahn M.
        • Marcus K.L.
        • Choudhary N.
        • Zhu H.
        • Markovic-Plese S.
        Differential reconstitution of T cell subsets following immunodepleting treatment with alemtuzumab (anti-CD52 monoclonal antibody) in patients with relapsing-remitting multiple sclerosis.
        J. Immunol. 2013; 191: 5867-5874