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.