Refractory chronic spontaneous urticaria after the use of alemtuzumab in multiple sclerosis

Abstract

A 40-year-old woman developed erythematous, raised and pruritic, migratory lesions on a daily basis affecting her whole body for the past 3 months; the appearance of the rash was consistent with urticaria. There was associated angioedema affecting her lips and face. Her medical history was significant for MS, diagnosed 9 years before, manifesting clinically with mobility, speech, and cognitive impairment. Initial treatment was with β-interferon and glatiramer acetate; however, disease relapse prompted switching to alemtuzumab, with 2 standard courses given 12 months apart (60 and 36 mg, respectively, the last dose given 12 months before the onset of rash), and achieved remission with a new baseline Expanded Disability Status Scale of 2.

Skin Autoimmunity Secondary to Alemtuzumab in a Tertiary Care Spanish Hospital

“…These cases share an autoimmune origin with cutaneous manifestations. As mentioned, cases of vitiligo 21,22 and alopecia 19,20 have been described before; a case of chronic spontaneous urticaria has been recently described, 23 and dermatitis is also mentioned as an ALZ-related event. 24…”

“…These cases share an autoimmune origin with cutaneous manifestations. As mentioned, cases of vitiligo 21,22 and alopecia 19,20 have been described before; a case of chronic spontaneous urticaria has been recently described, 23 and dermatitis is also mentioned as an ALZ-related event. 24 Figure The pathophysiology of vitiligo has been widely described as an autoimmune phenomenon against skin melanocytes, leading to the appearance of depigmented areas.…”

“…[5][6][7] However, there are few published cases of long-term skin autoimmune diseases after ALZ. Recently, isolated cases of alopecia areata, 19,20 vitiligo, 21,22 and refractory chronic spontaneous urticaria 23 have been reported.…”

“…Both a decrease in CD4 T-cells and an autoantibody-mediated disease process have been linked with this process and may explain its appearance after ALZ. 23,26 ALZ is known to be associated with exanthems or dermatitis in the setting of therapy. These findings could be related to hypersensitivity reactions, but also to immune dysregulation.…”

“…Both a decrease in CD4 T-cells and an autoantibody-mediated disease process have been linked with this process and may explain its appearance after ALZ. 23,26…”