奥克立珠单抗诱发的多发性硬化症组织性肺炎:病例报告和文献综述。

IF 0.8 Q3 MEDICINE, GENERAL & INTERNAL
Archive of clinical cases Pub Date : 2024-07-16 eCollection Date: 2024-01-01 DOI:10.22551/2024.43.1102.10291
Shaheryar Usman, Muhammad Cheema, Zoha Ghuman, Saleem Mustafa, Asma Iftikhar
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引用次数: 0

摘要

复发缓解型多发性硬化症患者在治疗过程中应接受改变病情疗法。推荐的治疗方案包括整合素拮抗剂疗法(包括纳他珠单抗)以及抗CD20单克隆抗体(如奥克利珠单抗、利妥昔单抗、ofatumumab和乌利昔单抗)。这些疗法可降低复发率,减缓脑部病灶的积累。疾病改变疗法的选择可能取决于患者的偏好、对胎儿的潜在伤害和特定药物的风险,需要通过跟踪临床复发和新的磁共振成像脑病变进行持续监测。纳妥珠单抗有发生进行性多灶性白质脑病的风险,尤其是抗 JCV 抗体阳性患者,因此需要定期监测。奥克利珠单抗、利妥昔单抗和乌利昔单抗会增加感染(尤其是呼吸道感染和皮肤感染)、输液反应和低丙种球蛋白血症的风险。此外,奥克利珠单抗还会增加患免疫介导的结肠炎和乳腺癌的风险,而且由于病毒再激活的风险,活动性乙型肝炎患者禁用。据悉,乌布鲁昔单抗与潜在的胎儿伤害有关。我们报告了这样一例病例:一名 42 岁的男性复发性多发性硬化症患者在服用奥克立珠单抗两周后出现持续发热和气短。尽管他接受了疑似肺炎的抗生素治疗,但症状依然存在。胸部 CT 扫描发现多灶性磨玻璃不透明,提示可能继发于奥克立珠单抗的组织化肺炎。大剂量皮质类固醇治疗后,患者的病情有所好转,这凸显了警惕极为罕见的奥克立珠单抗相关肺部副作用的重要性,以及及时采取适当干预措施的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Ocrelizumab-induced organizing pneumonia in multiple sclerosis: case report and literature review.

Patients with relapsing-remitting multiple sclerosis should be offered disease-modifying therapies as part of their management. Recommended options include integrin antagonist therapy including natalizumab as well as anti-CD20 monoclonal antibodies like, ocrelizumab, rituximab, ofatumumab, and ublituximab. These therapies reduce relapse rates and slow brain lesion accumulation. Disease-modifying therapies selection may depend on patient preferences, potential fetal harm, and specific drug risks, requiring continuous monitoring via tracking clinical relapses and new MRI brain lesions. Natalizumab carries a risk of progressive multifocal leukoencephalopathy, particularly in anti-JCV antibody-positive patients, necessitating regular monitoring. Ocrelizumab, rituximab, and ublituximab are associated with an increased risk of infections (especially respiratory and skin infections), infusion reactions, and hypogammaglobulinemia. Ocrelizumab additionally poses a heightened risk of immune-mediated colitis and breast cancer, and it is contraindicated for patients with active hepatitis B due to the risk of viral reactivation. Ublituximab has been noted to be linked to potential fetal harm. We report the case of a 42-year-old male with relapsing-remitting multiple sclerosis on ocrelizumab who developed persistent fever and shortness of breath, two weeks after his last ocrelizumab dose. Despite antibiotic treatment for suspected pneumonia, his symptoms persisted. A chest CT scan revealed multifocal ground-glass opacities suggestive of organizing pneumonia, likely secondary to ocrelizumab. The patient's condition improved with high-dose corticosteroids, underscoring the importance of vigilance for extremely rare ocrelizumab-associated pulmonary side effects and the need for prompt, appropriate intervention.

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