title: Drug-induced thrombocytopenia secondary to natalizumab treatment.
abstract: A 52-year-old woman with a 10-year history of relapsing-remitting multiple sclerosis (RRMS) was started on natalizumab after she developed side effects for interferon β-1a and glatiramer acetate. The patient presented with acute severe infusion reaction after the third treatment with natalizumab, developing whole-body purpura. Laboratory testing revealed progressive worsening thrombocytopenia up to 3 weeks following natalizumab discontinuation. Platelet antibodies to platelet-specific antigen as well as antibodies against natalizumab were positive. Bone marrow biopsy was negative. The patient was diagnosed with drug-induced immune thrombocytopenia (DITP) as a rare case of natalizumab side effect which was treated with intravenous methylprednisolone followed by rituximab with successful resolution of thrombocytopenia. The patient had a stable course of RRMS with no relapses and no brain MRI changes at 2 years after initiation of rituximab.
authors.affiliation: Department of Neurology, MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: David
authors.initials: D
authors.lastname: Cachia
authors.affiliation: University of Massachusetts, Worcester, Massachusetts, USA.
authors.forename: Saef
authors.initials: S
authors.lastname: Izzy
authors.affiliation: Department of Neurology, University of Massachusetts, Worcester, Massachusetts, USA.
authors.forename: Idanis
authors.initials: I
authors.lastname: Berriosmorales
authors.affiliation: Department of Neurology, University of Massachusetts, Worcester, Massachusetts, USA.
authors.forename: Carolina
authors.initials: C
authors.lastname: Ionete
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy; D000069442:Natalizumab; D011241:Prednisone / Q000627:therapeutic use; D000069283:Rituximab; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D000069442:Natalizumab; D000069283:Rituximab; D011241:Prednisone; D008775:Methylprednisolone