Hemophagocytic lymphohistiocytosis in 2 patients with multiple sclerosis treated with alemtuzumab

: Mika Saarela, Keerthi Senthil, Joanne Jones, Pentti J. Tienari, Merja Soilu-Hänninen, Laura Airas, Alasdair Coles, Jukka T. Saarinen

Publisher: LIPPINCOTT WILLIAMS & WILKINS

: 2018

: Neurology

: NEUROLOGY

: 90

: 18

: 849

: 851

: 3

: 0028-3878

: 1526-632X

DOI: https://doi.org/10.1212/WNL.0000000000005420

Alemtuzumab is a highly effective treatment of relapsing-remitting multiple sclerosis (RRMS) with a complex safety profile, including secondary autoimmunity in 40% of patients.(1) We report 2 cases of hemophagocytic lymphohistiocytosis (HLH) in patients after alemtuzumab treatment of RRMS. This hyperinflammatory syndrome consists of fever, lymphadenopathy, pancytopenia, liver abnormalities, hyperferritinemia, raised soluble interleukin 2 (IL-2) receptor, and hemophagocytosis; it may be secondary to malignancies, autoimmune diseases, or infections.(2) The table summarizes the diagnostic criteria for secondary HLH.