Elsevier

eNeurologicalSci

Volume 21, December 2020, 100279
eNeurologicalSci

Case report
Severe lymphopenia after subcutaneous cladribine in a patient with multiple sclerosis: To vaccinate or not?

https://doi.org/10.1016/j.ensci.2020.100279Get rights and content
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Highlights

  • We report a case of lethal influenza A infection with severe lymphopenia in an MS patient receiving s.c. cladribine.

  • Cladribine-related lymphopenia is usually mild to moderate, however severe lymphopenia may occur.

  • Annual influenza immunisation should be recommended for people with MS, especially those who are immunosuppressed.

Abstract

Objective

To describe a fatal case of influenza A pneumonia in a patient with severe lymphopenia after receiving subcutaneous cladribine to treat her multiple sclerosis (MS).

Methods

Case report.

Results

A 53-year-old woman developed fatal influenza pneumonia associated with grade 4 lymphopenia two months after receiving a total dose of 60mg subcutaneous cladribine. Despite treatment with oseltamivir, her condition deteriorated and the patient passed away after developing respiratory failure.

Conclusion

Cladribine-related lymphopenia is usually mild to moderate, however severe lymphopenia may occur. People with MS, especially those who are immunosuppressed, should be offered the inactivated influenza vaccine annually.

Keywords

Cladribine
Disease-modifying treatment
Lymphopenia
Adverse event
Influenza A virus
Multiple Sclerosis

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1

These authors contributed equally to the manuscript.