ObjectivesThe interleukin-6 (IL-6) inhibitor satralizumab is an established treatment for neuromyelitis optica spectrum disorder (NMOSD). Although IL-6 inhibitors are generally well-tolerated, serious infections, including sepsis, can occur. In this study, we compared the sepsis characteristics in NMOSD patients administered satralizumab (NMOSD-satralizumab) to those in rheumatoid arthritis patients administered tocilizumab (RA-tocilizumab), another IL-6 inhibitor. Methods We examined adverse event reports from the Japanese Pharmaceuticals and Medical Devices Agency regarding NMOSD-satralizumab from August 2020 to March 2022 and RA-tocilizumab from April 2008 to November 2019 (term 1) and to March 2022 (term 2). ResultsWe identified 6 sepsis cases in NMOSD-satralizumab, of which 5 (83%) developed from urinary tract infections (UTIs). Although data were unavailable for two patients, three cases had urologic complications in addition to recognized risk factors for serious infections, such as an older age, corticosteroid use, obesity, diabetes mellitus and motor disability. Urosepsis was relatively infrequent in RA-tocilizumab (term 1: 24.2%, term 2: 20.1%). Discussion Safe satralizumab use requires risk factor assessment to minimize the incidence of severe infections. Management of UTIs is also recommended.

The triad of Horner’s syndrome, ataxia and sensory disturbances clinically identifies patients with lateral medullary infarct (LMI). However, dermatomal temperature and pain sensory loss have rarely been reported in patients with LMI. We describe the case of a patient with LMI presenting solely with temperature and pain sensory disorder below the C5 sensory level. Magnetic resonance imaging findings demonstrated a small superficial infarction in the right lateral medulla oblongata, indicating that the sensory deficit was caused by a restricted infarction of the lateral spinothalamic tract. We emphasize the importance of adding LMI to a differential diagnosis of acute dermatomal sensory disturbance without other major symptoms of LMI, such as cranial nerve abnormalities, ataxia and Horner’s syndrome.

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