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Open AccessCase Report

Autoimmune Encephalitis and CSF Anti-GluR3 Antibodies in an MS Patient after Alemtuzumab Treatment

1
Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Faculty of Medicine and Psychology, Sapienza University, 00189 Rome, Italy
2
Faculty of Medicine and Psychology, Sapienza University, 00189 Rome, Italy
3
Neurology IV–Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
4
IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, 86077 Pozzilli, Italy
*
Authors to whom correspondence should be addressed.
Brain Sci. 2019, 9(11), 299; https://doi.org/10.3390/brainsci9110299
Received: 10 September 2019 / Revised: 26 October 2019 / Accepted: 28 October 2019 / Published: 30 October 2019
(This article belongs to the Special Issue Advances in Multiple Sclerosis Research)
A 45-year-old Italian woman, affected by relapsing–remitting multiple sclerosis (RR-MS) starting from 2011, started treatment with alemtuzumab in July 2016. Nine months after the second infusion, she had an immune thrombocytopenic purpura (ITP) with complete recovery after steroid treatment. Three months after the ITP, the patient presented with transient aphasia, cognitive deficits, and focal epilepsy. Serial brain magnetic resonance imaging showed a pattern compatible with encephalitis. Autoantibodies to glutamate receptor 3 peptide A and B were detected in cerebrospinal fluid and serum, in the absence of any other diagnostic cues. After three courses of intravenous immunoglobulin (0.4 mg/kg/day for 5 days, 1 month apart), followed by boosters (0.4 mg/kg/day) every 4–6 weeks, her neurological status improved and is currently comparable with that preceding the encephalitis. Autoimmune complications of the central nervous system during alemtuzumab therapy are relatively rare: only one previous case of autoimmune encephalitis following alemtuzumab treatment has been reported to date. View Full-Text
Keywords: multiple sclerosis; autoimmune diseases; immune thrombocytopenic purpura; autoimmune encephalitis; alemtuzumab; antibodies against GluR3 peptide multiple sclerosis; autoimmune diseases; immune thrombocytopenic purpura; autoimmune encephalitis; alemtuzumab; antibodies against GluR3 peptide
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Buscarinu, M.C.; Fornasiero, A.; Pellicciari, G.; Reniè, R.; Landi, A.C.; Bozzao, A.; Cappelletti, C.; Bernasconi, P.; Ristori, G.; Salvetti, M. Autoimmune Encephalitis and CSF Anti-GluR3 Antibodies in an MS Patient after Alemtuzumab Treatment. Brain Sci. 2019, 9, 299.

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