Necrotizing skin lesions and NA Bs development in a multiple sclerosis patient treated with IFNβ 1b

Abstract

A case of a severe necrotizing vasculopathic skin lesions occurred in a 43 year old women affected by multiple sclerosis (MS) submitted to IFNb-lb has been described. A fter two months of therapy the patient presented, in injection sites of the abdomen, arms and legs, numerous ulcers. A biopsy of the lesions was performed and evidenced confluent necro sis of the superficial and deep skin tissue with mild infiltration by inflammatory cells and thrombosis in deep blood vessels. The IFNb-lb was immediately discontinued and therapy with corticosteroids was started. A fter 12 months from the onset of the adverse reaction, the skin vasculopathic lesions cicatrised leaving sclerotic areas on the abdomen. Neutralizing antibodies against IFNb-lb (NA Bs) were strongly positive at the onset of the skin ulcers and slowly decreased until the recovery. A possible role of NA Bs in the development of the skin lesions has been considered.

Keywords

IFNβ-lb multiple sclerosis NABs skin ulcers

Get full access to this article

View all access options for this article.

References

PRISMS (Prevention of Relapses and Disability by Interferon beta-la Subcutaneously in Multiple sclerosis) study group . Randomized double-blind placebo-controlled study of inter-feron beta-la in relapsing-remitting multiple sclerosis . Lancet 1998; 352: 1498-1504 .

Walther EU , Hohlfeld R Multiple sclerosis side effects of interferon beta therapy and their management . Neurology 1999; 53: 1622-1627 .

Bertolotto A , Malucchi S , Mulano E , Castello A , Copobianco M , Mutani R. Interferon beta neutralizing antibodies in multiple sclerosis: neutralizing activity and cross-reactivity with three different preparations . Immunopharmacology 2000; 48: 95-100 .

Knobler RL , Kelley CL Interferon beta lb induced ulcerative skin lesions in MS (abstract) . J Neuroimmunol 1994; 54: 173-173 .

Sheremata WA , Taylor JR , Elgart OW. Severe necrotizing cutaneous lesions complicating treatment with interferon beta-lb . N Engl J Med 1995; 332: 1584-1584 .

Elgart OW , Shermata W , Ahn YS. Cutaneous reactions to recombinant human interferon beta-lb: the clinical and histo-logic spectrum . J Am Acad Dermatol 1997; 37: 553-557 .

Radziwill AJ , Courvoisier S. Severe necritizing cutaneous lesions complicating treatment with interferon b . J Neurol Neurosurg Psychiatry 1999; 67: 115-115 .

Cohen BA , Greenberger PA , Saini S. Delayed occurrence of a severe cutaneous reaction in a multiple sclerosis patient taking interferon beta-lb . Allergy-Asthma Proc 1998; 19: 85-88 .

Feldmann R , Low-Weiser H , Dushet P , Oschnait F. Necrotizing cutaneous lesions caused by interferon beta injections in a patient with multiple sclerosis . Dermatology 1997; 195: 52-53 .

10.

The IFNB Multiple Sclerosis Study Group and the University of British Columbia MS/MRI Analysis Group . Neutralizing antibodies during treatment of multiple sclerosis with inter-feron beta-I b: experience during the first three years . Neurology 1996; 47: 889-894 .