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February 05, 2019; 92 (6) Clinical/Scientific Notes

Simultaneous CMV and Listeria infection following alemtuzumab treatment for multiple sclerosis

Agustín Pappolla, Luciana Midaglia, Claudia P. Boix Rodríguez, Adaia Albasanz Puig, View ORCID ProfileMaiylyi Lung, Isabel Ruiz Camps, Joaquín Castilló, Patricia Mulero, Angela Vidal-Jordana, Georgina Arrambide, Breogán Rodriguez-Acevedo, Jaume Sastre-Garriga, Jordi Río, Manuel Comabella, Ingrid Galán, Mar Tintoré, Xavier Montalbán
First published December 26, 2018, DOI: https://doi.org/10.1212/WNL.0000000000006801
Agustín Pappolla
From the Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat) (A.P., L.M., J.C., P.M., A.V.-J., G.A., B.R.-A., J.S.-G., J.R., M.C., I.G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Internal Medicine (C.P.B.R.) and Center of Biomedical Research in Network on Neurodegenerative Diseases (CIBERNED) (C.P.B.R.), Sant Joan d'Alacant University Hospital, Alicante, Spain; Department of Neurology (A.P.), Hospital Italiano, Buenos Aires, Argentina; Department of Infectious Diseases (C.P.B.R., A.A.P., I.R.C.) and Microbiology Department (M.L.), Vall d'Hebron University Hospital, Barcelona, Spain; and Division of Neurology (X.M.), University of Toronto, St Michael's Hospital, Toronto, Canada.
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Luciana Midaglia
From the Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat) (A.P., L.M., J.C., P.M., A.V.-J., G.A., B.R.-A., J.S.-G., J.R., M.C., I.G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Internal Medicine (C.P.B.R.) and Center of Biomedical Research in Network on Neurodegenerative Diseases (CIBERNED) (C.P.B.R.), Sant Joan d'Alacant University Hospital, Alicante, Spain; Department of Neurology (A.P.), Hospital Italiano, Buenos Aires, Argentina; Department of Infectious Diseases (C.P.B.R., A.A.P., I.R.C.) and Microbiology Department (M.L.), Vall d'Hebron University Hospital, Barcelona, Spain; and Division of Neurology (X.M.), University of Toronto, St Michael's Hospital, Toronto, Canada.
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Claudia P. Boix Rodríguez
From the Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat) (A.P., L.M., J.C., P.M., A.V.-J., G.A., B.R.-A., J.S.-G., J.R., M.C., I.G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Internal Medicine (C.P.B.R.) and Center of Biomedical Research in Network on Neurodegenerative Diseases (CIBERNED) (C.P.B.R.), Sant Joan d'Alacant University Hospital, Alicante, Spain; Department of Neurology (A.P.), Hospital Italiano, Buenos Aires, Argentina; Department of Infectious Diseases (C.P.B.R., A.A.P., I.R.C.) and Microbiology Department (M.L.), Vall d'Hebron University Hospital, Barcelona, Spain; and Division of Neurology (X.M.), University of Toronto, St Michael's Hospital, Toronto, Canada.
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Adaia Albasanz Puig
From the Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat) (A.P., L.M., J.C., P.M., A.V.-J., G.A., B.R.-A., J.S.-G., J.R., M.C., I.G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Internal Medicine (C.P.B.R.) and Center of Biomedical Research in Network on Neurodegenerative Diseases (CIBERNED) (C.P.B.R.), Sant Joan d'Alacant University Hospital, Alicante, Spain; Department of Neurology (A.P.), Hospital Italiano, Buenos Aires, Argentina; Department of Infectious Diseases (C.P.B.R., A.A.P., I.R.C.) and Microbiology Department (M.L.), Vall d'Hebron University Hospital, Barcelona, Spain; and Division of Neurology (X.M.), University of Toronto, St Michael's Hospital, Toronto, Canada.
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Maiylyi Lung
From the Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat) (A.P., L.M., J.C., P.M., A.V.-J., G.A., B.R.-A., J.S.-G., J.R., M.C., I.G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Internal Medicine (C.P.B.R.) and Center of Biomedical Research in Network on Neurodegenerative Diseases (CIBERNED) (C.P.B.R.), Sant Joan d'Alacant University Hospital, Alicante, Spain; Department of Neurology (A.P.), Hospital Italiano, Buenos Aires, Argentina; Department of Infectious Diseases (C.P.B.R., A.A.P., I.R.C.) and Microbiology Department (M.L.), Vall d'Hebron University Hospital, Barcelona, Spain; and Division of Neurology (X.M.), University of Toronto, St Michael's Hospital, Toronto, Canada.
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Isabel Ruiz Camps
From the Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat) (A.P., L.M., J.C., P.M., A.V.-J., G.A., B.R.-A., J.S.-G., J.R., M.C., I.G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Internal Medicine (C.P.B.R.) and Center of Biomedical Research in Network on Neurodegenerative Diseases (CIBERNED) (C.P.B.R.), Sant Joan d'Alacant University Hospital, Alicante, Spain; Department of Neurology (A.P.), Hospital Italiano, Buenos Aires, Argentina; Department of Infectious Diseases (C.P.B.R., A.A.P., I.R.C.) and Microbiology Department (M.L.), Vall d'Hebron University Hospital, Barcelona, Spain; and Division of Neurology (X.M.), University of Toronto, St Michael's Hospital, Toronto, Canada.
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Joaquín Castilló
From the Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat) (A.P., L.M., J.C., P.M., A.V.-J., G.A., B.R.-A., J.S.-G., J.R., M.C., I.G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Internal Medicine (C.P.B.R.) and Center of Biomedical Research in Network on Neurodegenerative Diseases (CIBERNED) (C.P.B.R.), Sant Joan d'Alacant University Hospital, Alicante, Spain; Department of Neurology (A.P.), Hospital Italiano, Buenos Aires, Argentina; Department of Infectious Diseases (C.P.B.R., A.A.P., I.R.C.) and Microbiology Department (M.L.), Vall d'Hebron University Hospital, Barcelona, Spain; and Division of Neurology (X.M.), University of Toronto, St Michael's Hospital, Toronto, Canada.
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Patricia Mulero
From the Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat) (A.P., L.M., J.C., P.M., A.V.-J., G.A., B.R.-A., J.S.-G., J.R., M.C., I.G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Internal Medicine (C.P.B.R.) and Center of Biomedical Research in Network on Neurodegenerative Diseases (CIBERNED) (C.P.B.R.), Sant Joan d'Alacant University Hospital, Alicante, Spain; Department of Neurology (A.P.), Hospital Italiano, Buenos Aires, Argentina; Department of Infectious Diseases (C.P.B.R., A.A.P., I.R.C.) and Microbiology Department (M.L.), Vall d'Hebron University Hospital, Barcelona, Spain; and Division of Neurology (X.M.), University of Toronto, St Michael's Hospital, Toronto, Canada.
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Angela Vidal-Jordana
From the Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat) (A.P., L.M., J.C., P.M., A.V.-J., G.A., B.R.-A., J.S.-G., J.R., M.C., I.G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Internal Medicine (C.P.B.R.) and Center of Biomedical Research in Network on Neurodegenerative Diseases (CIBERNED) (C.P.B.R.), Sant Joan d'Alacant University Hospital, Alicante, Spain; Department of Neurology (A.P.), Hospital Italiano, Buenos Aires, Argentina; Department of Infectious Diseases (C.P.B.R., A.A.P., I.R.C.) and Microbiology Department (M.L.), Vall d'Hebron University Hospital, Barcelona, Spain; and Division of Neurology (X.M.), University of Toronto, St Michael's Hospital, Toronto, Canada.
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Georgina Arrambide
From the Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat) (A.P., L.M., J.C., P.M., A.V.-J., G.A., B.R.-A., J.S.-G., J.R., M.C., I.G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Internal Medicine (C.P.B.R.) and Center of Biomedical Research in Network on Neurodegenerative Diseases (CIBERNED) (C.P.B.R.), Sant Joan d'Alacant University Hospital, Alicante, Spain; Department of Neurology (A.P.), Hospital Italiano, Buenos Aires, Argentina; Department of Infectious Diseases (C.P.B.R., A.A.P., I.R.C.) and Microbiology Department (M.L.), Vall d'Hebron University Hospital, Barcelona, Spain; and Division of Neurology (X.M.), University of Toronto, St Michael's Hospital, Toronto, Canada.
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Breogán Rodriguez-Acevedo
From the Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat) (A.P., L.M., J.C., P.M., A.V.-J., G.A., B.R.-A., J.S.-G., J.R., M.C., I.G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Internal Medicine (C.P.B.R.) and Center of Biomedical Research in Network on Neurodegenerative Diseases (CIBERNED) (C.P.B.R.), Sant Joan d'Alacant University Hospital, Alicante, Spain; Department of Neurology (A.P.), Hospital Italiano, Buenos Aires, Argentina; Department of Infectious Diseases (C.P.B.R., A.A.P., I.R.C.) and Microbiology Department (M.L.), Vall d'Hebron University Hospital, Barcelona, Spain; and Division of Neurology (X.M.), University of Toronto, St Michael's Hospital, Toronto, Canada.
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Jaume Sastre-Garriga
From the Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat) (A.P., L.M., J.C., P.M., A.V.-J., G.A., B.R.-A., J.S.-G., J.R., M.C., I.G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Internal Medicine (C.P.B.R.) and Center of Biomedical Research in Network on Neurodegenerative Diseases (CIBERNED) (C.P.B.R.), Sant Joan d'Alacant University Hospital, Alicante, Spain; Department of Neurology (A.P.), Hospital Italiano, Buenos Aires, Argentina; Department of Infectious Diseases (C.P.B.R., A.A.P., I.R.C.) and Microbiology Department (M.L.), Vall d'Hebron University Hospital, Barcelona, Spain; and Division of Neurology (X.M.), University of Toronto, St Michael's Hospital, Toronto, Canada.
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Jordi Río
From the Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat) (A.P., L.M., J.C., P.M., A.V.-J., G.A., B.R.-A., J.S.-G., J.R., M.C., I.G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Internal Medicine (C.P.B.R.) and Center of Biomedical Research in Network on Neurodegenerative Diseases (CIBERNED) (C.P.B.R.), Sant Joan d'Alacant University Hospital, Alicante, Spain; Department of Neurology (A.P.), Hospital Italiano, Buenos Aires, Argentina; Department of Infectious Diseases (C.P.B.R., A.A.P., I.R.C.) and Microbiology Department (M.L.), Vall d'Hebron University Hospital, Barcelona, Spain; and Division of Neurology (X.M.), University of Toronto, St Michael's Hospital, Toronto, Canada.
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Manuel Comabella
From the Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat) (A.P., L.M., J.C., P.M., A.V.-J., G.A., B.R.-A., J.S.-G., J.R., M.C., I.G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Internal Medicine (C.P.B.R.) and Center of Biomedical Research in Network on Neurodegenerative Diseases (CIBERNED) (C.P.B.R.), Sant Joan d'Alacant University Hospital, Alicante, Spain; Department of Neurology (A.P.), Hospital Italiano, Buenos Aires, Argentina; Department of Infectious Diseases (C.P.B.R., A.A.P., I.R.C.) and Microbiology Department (M.L.), Vall d'Hebron University Hospital, Barcelona, Spain; and Division of Neurology (X.M.), University of Toronto, St Michael's Hospital, Toronto, Canada.
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Ingrid Galán
From the Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat) (A.P., L.M., J.C., P.M., A.V.-J., G.A., B.R.-A., J.S.-G., J.R., M.C., I.G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Internal Medicine (C.P.B.R.) and Center of Biomedical Research in Network on Neurodegenerative Diseases (CIBERNED) (C.P.B.R.), Sant Joan d'Alacant University Hospital, Alicante, Spain; Department of Neurology (A.P.), Hospital Italiano, Buenos Aires, Argentina; Department of Infectious Diseases (C.P.B.R., A.A.P., I.R.C.) and Microbiology Department (M.L.), Vall d'Hebron University Hospital, Barcelona, Spain; and Division of Neurology (X.M.), University of Toronto, St Michael's Hospital, Toronto, Canada.
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Mar Tintoré
From the Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat) (A.P., L.M., J.C., P.M., A.V.-J., G.A., B.R.-A., J.S.-G., J.R., M.C., I.G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Internal Medicine (C.P.B.R.) and Center of Biomedical Research in Network on Neurodegenerative Diseases (CIBERNED) (C.P.B.R.), Sant Joan d'Alacant University Hospital, Alicante, Spain; Department of Neurology (A.P.), Hospital Italiano, Buenos Aires, Argentina; Department of Infectious Diseases (C.P.B.R., A.A.P., I.R.C.) and Microbiology Department (M.L.), Vall d'Hebron University Hospital, Barcelona, Spain; and Division of Neurology (X.M.), University of Toronto, St Michael's Hospital, Toronto, Canada.
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Xavier Montalbán
From the Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat) (A.P., L.M., J.C., P.M., A.V.-J., G.A., B.R.-A., J.S.-G., J.R., M.C., I.G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; Department of Internal Medicine (C.P.B.R.) and Center of Biomedical Research in Network on Neurodegenerative Diseases (CIBERNED) (C.P.B.R.), Sant Joan d'Alacant University Hospital, Alicante, Spain; Department of Neurology (A.P.), Hospital Italiano, Buenos Aires, Argentina; Department of Infectious Diseases (C.P.B.R., A.A.P., I.R.C.) and Microbiology Department (M.L.), Vall d'Hebron University Hospital, Barcelona, Spain; and Division of Neurology (X.M.), University of Toronto, St Michael's Hospital, Toronto, Canada.
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Citation
Simultaneous CMV and Listeria infection following alemtuzumab treatment for multiple sclerosis
Agustín Pappolla, Luciana Midaglia, Claudia P. Boix Rodríguez, Adaia Albasanz Puig, Maiylyi Lung, Isabel Ruiz Camps, Joaquín Castilló, Patricia Mulero, Angela Vidal-Jordana, Georgina Arrambide, Breogán Rodriguez-Acevedo, Jaume Sastre-Garriga, Jordi Río, Manuel Comabella, Ingrid Galán, Mar Tintoré, Xavier Montalbán
Neurology Feb 2019, 92 (6) 296-298; DOI: 10.1212/WNL.0000000000006801

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Alemtuzumab, a humanized monoclonal antibody for the treatment of relapsing-remitting multiple sclerosis, produce the rapid depletion of all mature lymphocytes. For this reason, patients are at an increased risk of developing infections due to the reactivation of latent agents or acquired microorganisms. Most infections reported during the phase III trials were mild or moderate in severity, while serious infections were surprisingly uncommon.1 However, during the postmarketing use of alemtuzumab, several opportunistic infections have been reported.2–5 We describe a patient who presented simultaneous cytomegalovirus (CMV) reactivation and Listeria meningitis promptly following the first course of alemtuzumab.

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  • * These authors contributed equally to this work.

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received June 8, 2018.
  • Accepted in final form October 23, 2018.
  • © 2018 American Academy of Neurology
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