title: Listeria monocytogenes infection associated with alemtuzumab - - a case for better preventive strategies.
abstract: BACKGROUND
  The mortality of septicaemia, meningitis and encephalitis caused by Listeria monocytogenes is 20-40%. Twenty-one cases of invasive listeriosis associated with alemtuzumab, including at least 16 in patients with multiple sclerosis, have been published or reported to the World Health Organization Case Safety Reports Database. Three cases were fatal, including at least one patient treated for multiple sclerosis in 2016.
  
  
  METHODS
  We report a patient with multiple sclerosis who developed pyrexia, nausea and abdominal discomfort few hours after the third and last infusion of her second alemtuzumab cycle. An infusion related reaction was suspected. The patient had however eaten soft cheese and raw sausage 3 days prior to treatment, and L. monocytogenes septicaemia was diagnosed based on positive blood cultures.
  
  
  CONCLUSIONS
  Listeriosis associated with alemtuzumab is a potentially fatal condition that can mimic an infusion related reaction. As in most other previously reported cases symptoms started rapidly after the last infusion, suggesting that the patient already carried the bacteria prior to the alemtuzumab infusions. The summary of product characteristics recommends patients to avoid foods associated with listeria at least 1 month after treatment. This recommendation should include also the last weeks prior to treatment.
authors.affiliation: Department of Neurology, Akershus University Hospital, Lørenskog, Norway. trygve.holmoy@medisin.uio.no.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway. trygve.holmoy@medisin.uio.no.
authors.forename: Trygve
authors.identifier: http://orcid.org/0000-0002-2529-5664
authors.initials: T
authors.lastname: Holmøy
authors.affiliation: Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Hedda
authors.initials: H
authors.lastname: von der Lippe
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway.|Department of Microbiology, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Truls Michael
authors.initials: TM
authors.lastname: Leegaard
mesh_terms: D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D002611:Cheese / Q000382:microbiology*; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects*; D008088:Listeriosis / Q000209:etiology*; D008460:Meat / Q000382:microbiology*; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007155:Immunologic Factors; D000074323:Alemtuzumab
keywords: Adverse events; Alemtuzumab; Listeria monocytogenes; Multiple sclerosis; Treatment