Fulminant Central Nervous System Nocardiosis in a Patient Treated With Alemtuzumab for Relapsing-Remitting Multiple Sclerosis

Abstract

A woman in her late 40s w ith relapsing-remitting m u l t i p l e s c l e r o s i s ( M S ) w a s a d m itt e d b e c a u s e o f reduced ambulation and personality change in the previous 3 weeks. Her diagnosis of MS was made in 2007, and she was initially t re ate d w it h i nte r fe ro n beta-1a and switched to natalizumab because of ongoing disease activity. After 80 infusions, natalizumab was discontinued because of repeated relapses and seroconversion to positivity for JC virus. Her first cycle of alemtuzumab was given in February 2015 (Expanded Disability Status Sc ale score of 4.5), 18 weeks after the cessation of natalizumab treatment. Her medical history was remarkable for hypothyroidism, rec urrent infec tions, and an anorectic disorder (body mass index [calculated as weight in kilograms divided by height in meters squared] on admission, 14).