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Background: Autoimmune adverse events are the most relevant risks of alemtuzumab therapy. We present a patient with relapsing-remitting multiple sclerosis, who developed adult-onset Still's disease (AOSD) following alemtuzumab treatment. Case Presentation: The patient suffered from sore throat, swallowing difficulties, high spiking quotidian fever, generalized skin rash, arthritis, and myalgia 2 months after the second course of alemtuzumab. Laboratory tests revealed elevated acute-phase reactants, anemia, neutrophilic leukocytosis, and thrombocytosis. Serum calprotectin, interleukin-2, and interleukin-6 levels were strongly increased. Autoimmune, rheumatic, neoplastic, infectious, and granulomatous disorders were excluded. The NLRP1 and NLRP3 gene test, which was performed under the presumption of a cryopyrinassociated autoinflammatory syndrome, was negative. Based on the Yamaguchi and Fautrel criteria, and supported by the histological findings from a skin biopsy of the rash, the diagnosis of AOSD was established. Therapy with the anti-IL-1 agent (anakinra) led to a significant improvement of symptoms and blood parameters. However, anakinra had to be converted to rituximab due to generalized drug eruption. Following therapy with rituximab, the patient has fully recovered. Conclusion: The current case highlights AOSD as another rare and potentially life-threatening secondary autoinflammatory/autoimmune event following alemtuzumab treatment.

Axillary web syndrome as complication of axillary sentinel lymph node surgeryDear Editors, axillary web syndrome (AWS), first described in 2001 [1], is a complication of sentinel lymph node biopsy (SLNB). Arising after the procedure, it is a cord-like subcutaneous induration that may be tender to pressure, with tightening on abduction of the arm leading to a restriction of movement. This complication has been reported in approximately 5-10 % of patients after SLNB surgery for breast carcinoma [2, 3], and, hitherto in a few English-language articles exclusively, for melanoma [4]. Since it is also a characteristic complication in melanoma patients after axillary SLNB, treating physicians should be familiar with AWS. Here, we summarize the existing data on AWS, exemplified by three patients from our clinic.

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