Rhino-Sino-Cerebral Mucormycosis Associated with Long-Term Rituximab Therapy in Multiple Sclerosis: A Case Report and Review of the Literature
a case report and review of the literature
Abstract
Rituximab is a CD20 depleting agent, widely used as an off-label disease- modifying treatment (DMT) in treating multiple sclerosis (MS). The present study aimed to report the first case of rhino-sino-cerebral mucormycosis in a patient with secondary progressive MS (SPMS), treated with rituximab.The patient was a 38-year-old man with a history of SPMS treated with rituximab, who developed subacute left vision loss and impaired ocular movement. He also mentioned a concomitant severe headache and cheek swelling. Based on the brain and orbital magnetic resonance imaging (MRI) findings, rhino-sino-cerebral mucormycosis was suspected. Subsequent endoscopic examination confirmed the diagnosis. He underwent medical treatment with amphotericin B liposomal and surgical debridement leading to a significant clinical recovery. He was eventually discharged home with a solid recommendation to discontinue rituximab. The present report indicates a case of SPMS treated with rituximab, who developed rhino-sino-cerebral mucormycosis.
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12. Nandwani A, Jha P, Duggal R, Kher V. Invasive gastric mucormycosis and cytomegalovirus infection in an ABO incompatible renal transplant recipient. Indian J Nephrol [Internet]. 2015;25(6):373. Available from: http://www. indianjnephrol.org/text.asp?2015/25/6/373/157428
13. Kontoyiannis DP, Yang H, Song J, Kelkar SS, Yang X, Azie N, et al. Prevalence, clinical and economic burden of mucormyco- sis-related hospitalizations in the United States: a retrospec- tive study. BMC Infect Dis [Internet]. 2016 Dec 1;16(1):730. Available from: http://bmcinfectdis.biomedcentral.com/arti- cles/10.1186/s12879-016-2023-z
2. Varley CD, Winthrop KL. Long-Term Safety of Rituximab (Risks of Viral and Opportunistic Infections). Curr Rheumatol Rep [Internet]. 2021 Sep 16;23(9):74. Available from: https://link. springer.com/10.1007/s11926-021-01037-3
3. Vikse J, Jonsdottir K, Kvaløy JT, Wildhagen K, Omdal R. Tolerability and safety of long-term rituximab treatment in systemic inflammatory and autoimmune diseases. Rheumatol Int [Internet]. 2019 Jun 28;39(6):1083–90. Available from: http://link.springer.com/10.1007/s00296-019-04272-1
4. Ineichen B V, Moridi T, Granberg T, Piehl F. Rituximab treatment for multiple sclerosis. Mult Scler J [Internet]. 2020 Feb 25;26(2):137–52. Available from: http://journals.sagepub. com/doi/10.1177/1352458519858604
5. Barmettler S, Ong MS, Farmer JR, Choi H, Walter J. Association of Immunoglobulin Levels, Infectious Risk, and Mortality With Rituximab and Hypogammaglobulinemia. JAMA Netw Open [Internet]. 2018 Nov 2;1(7):e184169. Available from: http://jamanetworkopen.jamanetwork.com/article. aspx?doi=10.1001/jamanetworkopen.2018.4169
6. Tian X, Chen C, Ma L, Wei R, Li M, Wang X, et al. Efficacy and safety of rituximab in relapsing-remitting multiple sclerosis: A systematic review and meta-analysis. J Neuroimmunol [Internet]. 2020 Oct;347:577317. Available from: https:// linkinghub.elsevier.com/retrieve/pii/S016557282030326X
7. Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and Clinical Manifestations of Mucormycosis. Clin Infect Dis [Internet]. 2012 Feb 1;54(suppl_1):S23–34. Available from: http://academic.oup.com/ cid/article/54/suppl_1/S23/284492/Epidemiology-and-Clinical- Manifestations-of
8. Chisari CG, Sgarlata E, Arena S, Toscano S, Luca M, Patti F. Rituximab for the treatment of multiple sclerosis: a review. J Neurol [Internet]. 2022 Jan 8;269(1):159–83. Available from: https://link.springer.com/10.1007/s00415-020-10362-z
9. Mir I, Basnet S, Ellsworth D, Mohanty E. Pulmonary Mucormycosis in Chronic Lymphocytic Leukemia and Neutropenia. Case Rep Infect Dis [Internet]. 2018;2018:1– 4. Available from: https://www.hindawi.com/journals/ criid/2018/2658083/
10. Hill M, Pennington K, Midthun D. Pulmonary Mucormycosis: A Rare Cause of Hydropneumothorax. Chest [Internet]. 2020 Oct;158(4):A479. Available from: https://linkinghub.elsevier. com/retrieve/pii/S0012369220326465
11. Hung HC, Shen GY, Chen SC, Yeo KJ, Tsao SM, Lee MC, et al. Pulmonary Mucormycosis in a Patient with Systemic Lupus Erythematosus: A Diagnostic and Treatment Challenge. Case Rep Infect Dis [Internet]. 2015;2015:1–5. Available from: http://www.hindawi.com/journals/criid/2015/478789/
12. Nandwani A, Jha P, Duggal R, Kher V. Invasive gastric mucormycosis and cytomegalovirus infection in an ABO incompatible renal transplant recipient. Indian J Nephrol [Internet]. 2015;25(6):373. Available from: http://www. indianjnephrol.org/text.asp?2015/25/6/373/157428
13. Kontoyiannis DP, Yang H, Song J, Kelkar SS, Yang X, Azie N, et al. Prevalence, clinical and economic burden of mucormyco- sis-related hospitalizations in the United States: a retrospec- tive study. BMC Infect Dis [Internet]. 2016 Dec 1;16(1):730. Available from: http://bmcinfectdis.biomedcentral.com/arti- cles/10.1186/s12879-016-2023-z
| Files | ||
| Issue | Vol 7 No 6 (2022): November-December | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v7i6.12278 | |
| Keywords | ||
| Multiple sclerosis Rituximab B-Lymphocytes Mucormycosis | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Koosha M, Mehrparvar G, Paybast S. Rhino-Sino-Cerebral Mucormycosis Associated with Long-Term Rituximab Therapy in Multiple Sclerosis: A Case Report and Review of the Literature. CRCP. 2023;7(6):313-318.
