Interferon-β-1a
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Reactions 1321 - 2 Oct 2010 S Interferon-β-1a Acute renal failure, systemic lupus erythematosus and thrombotic microangiopathy: case report A 41-year-old man developed acute renal failure, systemic lupus erythematosus (SLE) and thrombotic microangiopathy following interferon-β-1a treatment for multiple sclerosis (MS). The man was diagnosed with MS, and initially received interferon-β-1a [Rebif] 22µg thrice weekly [route not stated] and corticosteroids. Following a relapse of MS with optic neuritis several months later, treatment was restarted with corticosteroids and interferon-β-1a 44µg three times a week. In 2004, a further course of corticosteroids was administered following development of expressive dysphasia, right-sided deafness and unsteadiness of gait. He was hospitalised in 2005 with pain between his shoulder blades. He had bilateral pleural effusions and pericardial rub. Laboratory findings indicated elevated creatinine, CRP at 138 mg/L and haemoglobin at 7.8 g/dL. His anti-ds DNA antibody, IgG anti-phospholipid antibody and ANA titre were positive. Chest X-ray indicated cardiomegaly and thoracic CT scan showed pericardial thickening and effusion. Interferon-β-1a was withdrawn and the man received pulsed methylprednisolone and diclofenac for pericardial pain. He developed acute kidney injury and his serum creatinine level and platelet count were 240 µmol/L and 60 × 10 9 /L, respectively. His activated partial thromboplastin time was prolonged and blood and protein were present on urinalysis. He also had seizures and a brain MRI indicated patchy signal changes and features suggestive of demyelination or small infarcts. He received pulsed cyclophosphamide and prednisolone. Florid thrombotic microangiopathy and ischaemic glomerular changes were evident on renal biopsy. Plasma exchange was performed on seven occasions in the ensuing 2 weeks. Further cyclophosphamide was administered, followed by mycophenolate. His prednisolone dose was decreased gradually. At last follow-up, his condition was stable with no anti-phospholipid antibodies and substantial recovery of kidney function. Hansen T, et al. Acute renal failure, systemic lupus erythematosus and thrombotic microangiopathy following treatment with beta-interferon for multiple sclerosis: Case report and review of the literature. NDT Plus 2: 466-468, Dec 2009. Available from: URL: http://dx.doi.org/10.1093/ndtplus/sfp113 - United Kingdom 803040664 1 Reactions 2 Oct 2010 No. 1321 0114-9954/10/1321-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Interferon-β-1a
Reactions 1321 - 2 Oct 2010
SInterferon-β-1a
Acute renal failure, systemic lupuserythematosus and thrombotic microangiopathy:case report
A 41-year-old man developed acute renal failure,systemic lupus erythematosus (SLE) and thromboticmicroangiopathy following interferon-β-1a treatment formultiple sclerosis (MS).
The man was diagnosed with MS, and initially receivedinterferon-β-1a [Rebif] 22µg thrice weekly [route notstated] and corticosteroids. Following a relapse of MS withoptic neuritis several months later, treatment was restartedwith corticosteroids and interferon-β-1a 44µg three times aweek. In 2004, a further course of corticosteroids wasadministered following development of expressivedysphasia, right-sided deafness and unsteadiness of gait.He was hospitalised in 2005 with pain between hisshoulder blades. He had bilateral pleural effusions andpericardial rub. Laboratory findings indicated elevatedcreatinine, CRP at 138 mg/L and haemoglobin at 7.8 g/dL.His anti-ds DNA antibody, IgG anti-phospholipid antibodyand ANA titre were positive. Chest X-ray indicatedcardiomegaly and thoracic CT scan showed pericardialthickening and effusion.
Interferon-β-1a was withdrawn and the man receivedpulsed methylprednisolone and diclofenac for pericardialpain. He developed acute kidney injury and his serumcreatinine level and platelet count were 240 µmol/L and60 × 109/L, respectively. His activated partialthromboplastin time was prolonged and blood and proteinwere present on urinalysis. He also had seizures and a brainMRI indicated patchy signal changes and featuressuggestive of demyelination or small infarcts. He receivedpulsed cyclophosphamide and prednisolone. Floridthrombotic microangiopathy and ischaemic glomerularchanges were evident on renal biopsy. Plasma exchangewas performed on seven occasions in the ensuing 2 weeks.Further cyclophosphamide was administered, followed bymycophenolate. His prednisolone dose was decreasedgradually. At last follow-up, his condition was stable withno anti-phospholipid antibodies and substantial recovery ofkidney function.Hansen T, et al. Acute renal failure, systemic lupus erythematosus and thromboticmicroangiopathy following treatment with beta-interferon for multiple sclerosis:Case report and review of the literature. NDT Plus 2: 466-468, Dec 2009.Available from: URL: http://dx.doi.org/10.1093/ndtplus/sfp113 - UnitedKingdom 803040664
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Reactions 2 Oct 2010 No. 13210114-9954/10/1321-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
