RT Journal Article
SR Electronic
T1 Acquired haemophilia A complicating alemtuzumab therapy for multiple sclerosis
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr-2017-223016
DO 10.1136/bcr-2017-223016
VO 2017
A1 Georgia McCaughan
A1 Jennifer Massey
A1 Ian Sutton
A1 Jennifer Curnow
YR 2017
UL http://casereports.bmj.com/content/2017/bcr-2017-223016.abstract
AB Alemtuzumab is a highly efficacious therapy used in the treatment of multiple sclerosis (MS), but uncoupling of T and B cell repopulation during immune reconstitution associates with an increasing range of secondary B cell-mediated autoimmune complications. A 34-year-old woman developed Graves’ disease 11 months following an initial course of alemtuzumab treatment for MS. Nine months following the second treatment with alemtuzumab, the patient presented with spontaneous intramuscular and subcutaneous haemorrhage due to development of an inhibitory autoantibody to coagulation factor VIII. Acquired haemophilia A (AHA) is an extremely rare complication in patients treated with alemtuzumab. Treatment with rituximab may induce a rapid remission of AHA; however, the patient’s high John Cunningham virus (JCV) antibody index and alemtuzumab-induced T cell lymphopenia may lead to an increased risk of progressive multifocal leucoencephalopathy, a potential complication which was unacceptable to the patient.