Figure 1 : Cutaneous drug reaction lesions. Petechiae in a 58-year-old Caucasian woman on left antecubital (A) and lower back (B) one day after receiving the second dose of Alemtuzumab.
3. Discussion
Alemtuzumab is known as one of the medications used in patients with relapsing-remitting Multiple Sclerosis who have not responded to other drugs. This medication has some side effects, such as headache, rash, itching, fever, fatigue, hypothyroidism, redness of the face and neck, and more.(3)
There are many underlying causes that can lead to the development of generalized petechiae, including prolonged straining, infectious diseases and adverse effects of medications. Similarly, there are several reasons for epistaxis, such as nose picking, dry air, trauma to the nose, and medication side effects. Laboratory tests and a physical examination of the patient ruled out all of these causes except for the medication’s adverse effect.
Adverse skin reactions to drugs typically begin within 12 to 24 hours after exposure.(4)
Cuker et al. reported a case series of six patients with MS treated with Alemtuzumab, resulting in the development of Immune Thrombocytopenia (ITP). Five of these patients achieved complete remission after treatment, while one unfortunately succumbed to the condition, underscoring the need for serious consideration of this adverse effect.(5)
The patient’s symptoms manifested one day after receiving the second dose of Alemtuzumab, making a drug reaction a highly plausible explanation for these symptoms. Although rare
To the best of our knowledge, this is the first case report of generalized petechiae and epistaxis following treatment with Alemtuzumab, which was completely resolved after treatment. This case report suggests that Alemtuzumab may induce changes that lead to epistaxis, as nasal bleeding is not routinely observed in MS patients.
4. Conclusion
Generalized petechiae and epistaxis are rare side effects of Alemtuzumab treatment in MS patients. However, as the use of Alemtuzumab in MS treatment increases, healthcare providers should recognize and understand this adverse reaction pattern to improve clinical management and inform patients about potential adverse effects.
Further research endeavors are imperative to investigate potential underlying factors within the MS patient population that might render them more susceptible to adverse effects such as generalized petechiae and epistaxis following Alemtuzumab treatment.