Highlights
- •The comorbidity of sickle cell disease requires significant considerations in the management of MS.
- •If corticosteroids are used to treat an MS exacerbation in a patient with SCD, pre-treating with automated red blood cell exchange should strongly be considered.
- •Plasma exchange may also be considered in the treatment of an MS exacerbation in a patient with SCD.
- •Natalizumab and dimethyl fumarate are disease-modifying therapies currently being investigated pre-clinically as potential therapeutic options for SCD.
Abstract
Background
Comorbidities can impose diagnostic and treatment challenges in patients with multiple
sclerosis (MS). Sickle cell disease (SCD) and MS are both inflammatory diseases featuring
immune system dysregulation, and the reciprocal interaction of these diseases deserves
investigation.
Methods/Results
We present the case of a 28-year-old woman with SCD who developed a sickle cell crisis
and acute chest syndrome during corticosteroid treatment for a first MS attack. We
then provide a review of the literature on co-management of SCD and MS. In patients
with SCD experiencing an acute MS exacerbation, pre-treatment with red blood cell
exchange transfusion before corticosteroids may reduce adverse vaso-occlusive events.
Plasma exchange may also be considered. Finally, we discuss innovative pre-clinical
research that suggests that natalizumab or dimethyl fumarate may ameliorate SCD symptoms
while preventing MS relapses; human trials, however, are needed.
Conclusion
The co-occurrence of inflammatory disorders, in this case MS and SCD, requires providers
to appropriately manage each condition with consideration of the other. Future studies
may generate shared avenues for treatment.
Keywords
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References
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- Case series supporting heme detoxification via therapeutic plasma exchange in acute multiorgan failure syndrome resistant to red blood cell exchange in sickle cell disease.Transfusion. 2018; 58: 470-479
- Dimethyl fumarate increases fetal hemoglobin, provides heme detoxification, and corrects anemia in sickle cell disease.JCI Insight. 2017; 2: 1-16
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Article info
Publication history
Published online: July 28, 2020
Accepted:
July 27,
2020
Received in revised form:
July 15,
2020
Received:
May 15,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
