Alemtuzumab-induced Thyroid Eye Disease Successfully Treated with a Single Low Dose of Rituximab

Overview

Journal Eur Thyroid J

Specialties Endocrinology
Oncology

Date 2024 Mar 12

PMID 38471303

Authors

Ilaria Muller

Sara Maioli

Mirco Armenti

Laura Porcaro

Nicola Curro

Elisabetta Iofrida

Lorenzo Pignataro

Jacopo Manso

Caterina Mian

Jens Geginat

Mario Salvi

Affiliations

Soon will be listed here.

Abstract

Introduction: Secondary thyroid autoimmunity, especially Graves' disease (GD), frequently develops in patients with multiple sclerosis (MS) following alemtuzumab treatment (ALTZ; anti-CD52). Thyroid eye disease (TED) can also develop, and rituximab (RTX; anti-CD20) is a suitable treatment.

Case Presentation: A 37-year-old woman with MS developed steroid-resistant active moderate-to-severe TED 3 years after ALTZ, that successfully responded to a single 500 mg dose of i.v. RTX. Before RTX peripheral B-cells were low, and were totally depleted immediately after therapy. Follow-up analysis 4 years post ALTZ and 1 year post RTX showed persistent depletion of B cells, and reduction of T regulatory cells in both peripheral blood and thyroid tissue obtained at thyroidectomy.

Conclusion: RTX therapy successfully inactivated TED in a patient with low B-cell count derived from previous ALTZ treatment. B-cell depletion in both thyroid and peripheral blood was still present 1 year after RTX, indicating a likely cumulative effect of both treatments.

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