Skin Autoimmunity Secondary to Alemtuzumab in a Tertiary Care Spanish Hospital.

Background and Objectives: The most common adverse events (AEs) after alemtuzumab (ALZ) include adverse infusion reactions, infections, and autoimmune disorders. Skin AEs are common during infusion, but there are few reported cases of long-term skin autoimmune disease. Methods: A retrospective case series of patients developing long-term autoimmune skin disorders after ALZ administration in a tertiary care hospital. Results: Of 133 patients treated with ALZ, 8 patients (6.02%) developed 9 autoimmune cutaneous AEs, including 4 events of alopecia areata, 2 of vitiligo, 2 of chronic urticaria, and 1 of inflammatory atrichia. Three of them occurred between the first and the second infusion. Discussion: The lesions described are secondary to autoimmune disorders, probably related to immune dysregulation because of a differential lymphocyte repopulation after ALZ. Autoimmune cutaneous AEs may be frequent, and it would be recommended to monitor its appearance to treat them.

Vitíligo con fenómeno de Koebner en una paciente con esclerosis múltiple tratada con alemtuzumab / Vitiligo with Koebner phenomenon in a patient with multiple sclerosis treated with alemtuzumab

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Agrupación de casos de síndrome de Guillain-Barré atípico: ¿es necesario redefinir los criterios diagnósticos y los protocolos microbiológicos? / Atypical Guillain-Barré syndrome clustering: is it necessary to reconsider the diagnostic criteria and microbiological protocol?

Introducción. El síndrome de Guillain-Barré se define clásicamente como una polirradiculopatía aguda simétrica ascendente, si bien existen variantes atípicas que dificultan el diagnóstico. Casos clínicos. Se recogen las historias clínicas de seis pacientes de nuestra área hospitalaria durante el primer trimestre de 2013. Se han realizado punciones lumbares, electroneurograma-electromiograma y analíticas con autoinmunidad en todos los casos. El conjunto de la muestra destaca por la presencia de características atípicas, como hiporreflexia tardía, mayor frecuencia de asimetría y afectación distal, así como fiebre inicial. Desde el punto de vista neurofisiológico, todos los pacientes presentan formas axonales de tipo sensitivomotoras y las alteraciones de la onda F son el dato más precoz. Se identifica una variante de síndrome de Miller Fisher asociada a paresia faciocervicobraquial y síndrome de vasoconstricción cerebral reversible. Otro caso aúna las variantes de paresia braquial bilateral y polirradiculopatía lumbar en el contexto de infección aguda por influenza A. La variante saltatoria ha sido demostrada en otro paciente. Todos los pacientes han recibido tratamiento con inmunoglobulinas, y en dos de ellos se sumó la plasmaféresis como terapia adicional. Conclusiones. La agrupación de seis casos axonales con características clínicas atípicas justifica la necesidad del conocimiento de estas variantes para lograr un diagnóstico y un tratamiento precoz. La hiporreflexia tardía y las formas faciocervicobraquiales, saltatorias y lumbares deben considerarse dentro del espectro del síndrome de Guillain-Barré. El estudio etiológico debe incluir el cribado de numerosos patógenos, entre los que debe incluirse el virus influenza (AU)

Introduction. Guillain-Barré syndrome is classically defined as a symmetrical ascending acute polyradiculoneuropathy, although there are atypical variants that make diagnosis difficult. CASE REPORTS. The medical data of six patients in our hospital area are collected during the first quarter of 2013. Lumbar punctures, imaging, neurophysiological studies, ganglioside antibodies and serologies have been proposed in all cases. We focus on the atypical features as late hyporeflexia, increased frequency of asymmetry and distal paresis and initial fever. From a neurophysiological point of view, all patients presented sensorimotor axonal forms. The most consistent datas in early studies is the F wave’s alteration. A Miller Fisher variant associated with faciocervicobraquial paresis and cerebral reversible vasoconstriction syndrome has been detected. A bilateral brachial paresis and lumbar polyradiculopathy in the context of influenza A infection is other interesting case. The saltatory variant with cranial nerve involvement and lower limbs paresis has been demonstrated in one patient. Bands in cerebrospinal fluid are positive in three cases and anti-ganglioside antibodies in one patient. The syndrome of inappropriate secretion of antidiuretic hormone may explain some of the hyponatremias registered. The first line of treatment are inmunoglobulins in all patients. Plasmapheresis exchanges has been used as an additional therapy in four cases. Conclusions. These clusters of six axonal cases with atypical clinical features justifies the need for knowledge of these variants in order to achieve an early treatment. Late hyporeflexia and brachialfaciocervico, saltatory and lumbar forms should be considered in the spectrum of Guillain-Barré syndrome. The etiological study should rule out a lots of pathogens as influenza (AU)

Efficacy of the Treatments Used in Multiple Sclerosis: From Meta-analysis to Number Needed to Treat.

The aim of this study was to analyze the efficacy of drugs used in relapsing-remitting multiple sclerosis, first- and second-line drugs, using the number needed to treat (NNT) as a measure of efficacy. METHODS: Data from randomized clinical trials were analyzed for 3 categories of clinical efficacy outcomes: relapse, change in Expanded Disability Status Scale, and number of new lesions in magnetic resonance imaging. Meta-analysis results are expressed as odds ratios. RESULTS: The global odds ratio was 0.41 (95% confidence interval [CI], 0.34-0.49). For analyzed clinical outcomes, the odds ratio was less for second-line drugs (odds ratio, 2.0). For all studied clinical conditions, in the control group, 47 of 100 patients do not get benefits, compared with 25 (95% CI, 18-32 patients) of 100 for the active treatment group. The NNT was 5 patients (95% CI, 4-7 patients). For the proportion of patients free of relapses, in the control group, 56 of 100 patients had a relapse at 2 years, compared with 37 of 100 patients in the treatment group, with an NNT of 6 patients (95% CI, 5-8 patients). CONCLUSIONS: Active treatments produced statistically significant improvements compared with placebo.