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Abstract Details

Guillain-Barré Syndrome After Alemtuzumab Treatment in a Patient with Multiple Sclerosis: a Case Report
Multiple Sclerosis
P6 - Poster Session 6 (5:30 PM-6:30 PM)

Alemtuzumab is a humanized monoclonal antibody against CD52,which is expressed on T and B lymphocytes and approved originally for chronic lymphocytic leukemia and recently for relapsing-remitting multiple sclerosis(RRMS).Alemtuzumab treatment has been linked to cases of opportunistic infections,serious allergic reactions,and several autoimmune diseases.



A 52-year-old male patient with RRMS presented with left hemiparesis.The patient was diagnosed with RRMS in 2007.He received interferon beta-1a,natalizumab,fingolimod,rituximab,and ocrelizumab treatments that were considered to be inefficient,and therefore switching to alemtuzumab was decided.Before starting alemtuzumab,his neurological examination revealed mild dysarthria,mild bilateral upper extremity paresis(BMRC 4/5),prominent spastic paraparesis(BMRC 2/5),and walking difficulty(EDSS 6,5).After four days of intravenous alemtuzumab administration(12 mg/day),the patient received ertapenem due to a urinary tract infection caused by E. coli.The final dose of alemtuzumab was delivered after two weeks of antibiotic treatment.After 51 days of the last alemtuzumab dose,the patient complained of increased numbness and weakness in both lower and upper extremities.His routine blood and urine tests were within normal limits.Eighteen days after the onset of the symptoms,we found left peripheral facial palsy,quadriparesis with neck extensor muscle weakness,hypotonia,and areflexia with an EDSS of 8,5.The patient’s brain and cervical spinal MRIs revealed no new lesions.His electromyography revealed an acute inflammatory demyelinating polyneuropathy(AIDP) with predominant motor fiber involvement.The patient’s cerebrospinal fluid (CSF) analysis revealed an elevated protein level(88 mg/dl,normal range:15–45) without any cells.Serum and CSF anti-ganglioside antibodies were negative.With the diagnosis of Guillain-Barré syndrome(GBS),he was treated with intravenous immunoglobulin(2 g/kg/day) for five days.Symptoms and signs were improved gradually,and the patient was discharged ten days later with an EDSS score of 7.0.


There are several reports of GBS after alemtuzumab treatment in patients with leukemia.However,in MS patients,there is only one published case of acute motor axonal neuropathy that occurred after the alemtuzumab treatment.GBS should also be considered in patients with subacute neurological worsening after the alemtuzumab treatment.

Hasim Gezegen, MD (Istanbul University)
Mr. Gezegen has nothing to disclose.
Ozgu Kizek, MD (Gumushane State Hospital) Dr. Kizek has nothing to disclose.
Tuncay Gunduz, MD (ISTANBUL UNIVERSITESI NOROLOJI SERVISI) Dr. Gunduz has nothing to disclose.
Mefkure Eraksoy, MD (ISTANBUL UNIVERSITY) Dr. Eraksoy has nothing to disclose.
Murat Kurtuncu, MD (Istanbul University) Dr. Kurtuncu has nothing to disclose.