Scleromyxedema in a patient with multiple sclerosis and monoclonal gammopathy on interferon beta-1a.
BACKGROUND
Animal studies have shown that some human monoclonal antibodies promote myelin repair in models of demyelinating disease. Scleromyxedema is a dermatologic disorder associated with a monoclonal gammopathy and neurologic manifestations. The reason for occurrence of cutaneous reactions in interferon treated patients is unknown.


METHODS
A 37-year-old woman was started on weekly interferon beta-1a (IFN beta-1a) following a diagnosis of multiple sclerosis (MS). After having been on interferon therapy for three years, she developed skin lesions secondary to scleromyxedema. Her IFN beta-1a was discontinued and intravenous immunoglobulin therapy was started for her scleromyxedema. At a six-month follow up, her skin lesions improved and there was no recurrence of neurologic symptoms.


CONCLUSIONS
This is the first report of occurrence of scleromyxedema in a patient with MS. While this could be a chance association, it does raise the question if her neurologic manifestations could be secondary to scleromyxedema. Further research into the mechanism of IFN related cutaneous side effects is needed. Evidence regarding the remyelinating nature of human monoclonal antibodies raises interest in the potential therapeutic role these antibodies may have.
Kumar
Neeraj
N
Department of Neurology, Mayo Medical and Graduate Schools, Rochester, MN 55905, USA. kumar.neeraj@mayo.edu
Rodriguez
Moses
M
D000276:Adjuvants, Immunologic / Q000009:adverse effects*; D000328:Adult; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D000068556:Interferon beta-1a; D016899:Interferon-beta / Q000009:adverse effects*; D017512:Lichenoid Eruptions / Q000139:chemically induced* / Q000628:therapy; D009103:Multiple Sclerosis / Q000150:complications / Q000188:drug therapy*; D009230:Myxedema / Q000139:chemically induced* / Q000628:therapy; D010265:Paraproteinemias / Q000150:complications / Q000188:drug therapy*
D000276:Adjuvants, Immunologic; D016756:Immunoglobulins, Intravenous; D016899:Interferon-beta; D000068556:Interferon beta-1a