title: Simultaneous early-onset immune thrombocytopenia and autoimmune thyroid disease following alemtuzumab treatment in relapsing-remitting multiple sclerosis.
abstract: We report two cases of patients with relapsing-remitting multiple sclerosis with early-onset thrombocytopenia and autoimmune thyroid disease after the first treatment course with 60-mg alemtuzumab.
  
  
  
  Case series and review of the literature.
  
  
  
  Both patients showed severe thrombocytopenia with platelet counts of 2 × 10(9) and 11 × 10(9)/L, respectively, as well as increased thyroid antibodies within only a few months after initiating alemtuzumab treatment (11 and 9 months). Both patients responded considerably well to medical therapy including corticosteroids and intravenous immunoglobulins with slow platelet recovery over several weeks. Interestingly, both patients were previously treated with fingolimod and showed a marked lymphocytopenia that led to discontinuation.
  
  
  
  These cases emphasize the necessity of careful clinical surveillance and proper education of patients treated with alemtuzumab as proposed by the safety-monitoring program. Previous severe lymphocytopenia under therapy with other disease-modifying therapies may be a risk factor for the development of immune thrombocytopenia.
authors.affiliation: Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany/Departments of Neurology and Haematology, University of Duisburg-Essen, Duisburg, Germany mark.obermann@uni-due.de.
authors.forename: Mark
authors.initials: M
authors.lastname: Obermann
authors.affiliation: Department of Neurology, University of Münster, Münster, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Ruck
authors.affiliation: Department of Neurology, University of Münster, Münster, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Pfeuffer
authors.affiliation: Departments of Neurology and Haematology, University of Duisburg-Essen, Duisburg, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Baum
authors.affiliation: Department of Neurology, University of Münster, Münster, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Wiendl
authors.affiliation: Department of Neurology, University of Münster, Münster, Germany.
authors.forename: Sven G
authors.initials: SG
authors.lastname: Meuth
mesh_terms: D000328:Adult; D000074323:Alemtuzumab / Q000009:adverse effects*; D001327:Autoimmune Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D015551:Autoimmunity / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D012307:Risk Factors; D013959:Thyroid Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000074323:Alemtuzumab
keywords: Alemtuzumab; adverse events; early-onset; immune thrombocytopenia; multiple sclerosis; risk factors; side effects; treatment safety