Recurrent infection with Pseudomonas aeruginosa during eculizumab therapy in an allogeneic hematopoietic stem cell transplant recipient

Severe Infection of <i>Pseudomonas aeruginosa</i> during Eculizumab Therapy for Paroxysmal Nocturnal Hemoglobinuria

“…Previous hospitalization and exposure to antibiotics in the past might have led to a carrier state of P. aeruginosa as well. These multiple risk factors, including eculizumab administration, might have played accumulating roles in triggering repeated infections, as in the previous report ( 8 ).…”

“…However, less is known about the association of eculizumab and other infections aside from N. meningitides infection ( 7 ). Serious infections by other pathogens have been only anecdotally reported, including P. aeruginosa ( 8 ), Aspergillus niger ( 9 ), polyomavirus JC ( 10 ) and Herpes simplex ( 11 ). Among them, Webb et al reported a case of fatal P. aeruginosa bacteremia after eculizumab administration for atypical hemolytic uremic syndrome, implying that other less common therapy-related infectious consequences may have been under-recognized and that further studies should be performed ( 8 ).…”

Complement and Bacterial Infections: From Molecular Mechanisms to Therapeutic Applications

“…Although it is often stated that C5 and the MAC are only crucial to protect against Neisseria, we believe that the overall immune status of the patient receiving complement inhibitory therapy will determine their susceptibility to additional infections. Indeed, recent case reports showed that eculizumab treatment also predisposes patients to bacteria other than Neisseria (Pseudomonas aeruginosa [92,93], E. coli, and Enterococcus faecium [94]), thus underscoring the eminent role of C5 and MAC in defense against all invading bacteria.…”

Ecthyma Gangrenosum in Paroxysmal Nocturnal Hemoglobinuria

“…The literature suggests a possible underlying pathophysiological association between eculizumab and PA since the complement is known to play an important role in the innate defense against PA and the terminal complement might have a role in the effective killing of these bacteria [6]. …”

“…For example, a 34-year-old man, who underwent a haploidentical peripheral blood stem cell transplant for progressive Hodgkin disease complicated by an atypical hemolytic uremic syndrome with recurrent infections with PA during eculizumab therapy, finally died from multiple posttransplant complications including PA pneumonia [6]. A 73-year-old man with PNH developed PA cholecystitis, liver abscess, and bacteremia during eculizumab therapy, successfully controlled with antibiotics, granulocyte colony-stimulating factor, and cholecystectomy [7].…”