Microangiopathy in patient with multiple sclerosis in therapy with betainterferon

Dipartimento di Cardiochirurgia e dei Trapianti, Ospedale Monaldi, Napoli, Italy
Dipartimento di Medicina di Precisione, Universita della Campania Luigi Vanvitelli, Napoli, Italy
First Infectious Diseases Unit, Azienda Ospedaliera di Rilievo Nazionale dei Coli, P.O. Cotugno, 80131 Naples, Italy
Unit Emerging Infectious Disease, Ospedali dei Colli, P.O. D. Cotugno, Naples, Italy

Scientific Tracks Abstracts: Health Sci J

Abstract:

Background A 49-year-old man was hospitalized for fever, haemolytic anemia and thrombocytopenia. In medical history had multiple sclerosis in treatment with interferon beta1b (IFN-1b). Case history Thrombotic microangiopathy was revealed by ADAMTS13 activity lower than 5%. Because of anemia and thrombocytopenia, IFN- 1b was interrupted and caplacizumab was started1. After 21 days of caplacizumab, was obtained resolution of PTT but haemolytic anemia hadn’t resolved. Haematological malignancies were excluded. 2 set of blood culture resulted positive for Streptococcus mitis oralis, echocardiogram showed infective endocarditis on tricuspid valve and was started antibiotic therapy. CT angiography revealed pulmonary embolism but no deep vein thrombosis therapy with low-molecular-weight-heparin was started. CT PET-scan revealed multiple muscle abscesses, metastatic foci of infective endocarditis. Nevertheless, it was persistence of haemolytic anemia with positive direct Coombs test, with mild anemia. Because of the worsening of hemodynamic status, cardiac surgery was performed. Anticoagulant therapy with warfarin was started. Steroid tapering was done and the burden of abscesses was improved. Discussion PTT is a thrombotic microangiopathy classified in idiopathic or secondary. It may be possible that this pathology is caused by using IFN-1b or by endocarditis. A relation between PTT and using IFN-1b was described.2 References 1. Peyvandi F, Cataland S, Scully M, Coppo P, Knoebl P et al. (2021) Caplacizumab prevents refractoriness and mortality in acquired thrombotic thrombocytopenic purpura: integrated analysis. Blood Adv 5: 2137-2141. 2. Malekzadeh MM, Alizadeh R, Aghsaeifard Z, Sahraian MA (2021) Thrombotic Microangiopathy in Interferon-beta-Treated Multiple Sclerosis Patient. Clin Case Rep 8: 1061-1064.

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