Autoimmune Hepatitis During Treatment of Multiple Sclerosis with Alemtuzumab (P5.350)

Objective: To report the first case of autoimmune hepatitis during treatment with alemtuzumab. Background: Alemtuzumab is an anti-CD52 monoclonal antibody used in the treatment of relapsing-remitting multiple sclerosis. A number of secondary autoimmune disease have been associated with this therapy. The most common secondary autoimmune diseases include thyroiditis, immune thrombocytopenic purpura, and anti-glomerular basement membrane disease. To our knowledge, no cases of autoimmune hepatitis have been previously reported. Design/Methods: Pertinent clinical data was extracted and reviewed. Literature searches through PubMed and Web of Knowledge revealed no prior documented cases of autoimmune hepatitis associated with alemtuzumab therapy. Results: The patient is a 33-year-old female who first received alemtuzumab in September 2015. Her only prior disease-modifying therapy was fingolimod. Her course was complicated by the early development of Graves’ disease 6 months after her first series of infusions. Seven months after her second series and 19 months from her initial exposure to alemtuzumab, she developed a precipitous increase in her liver function tests, peaking at AST 467 and ALT 606 in August 2017. A comprehensive work-up was performed, and no infectious, metabolic, or toxic cause was found. There were no symptoms of acalculous cholecystitis and ultrasound of the gallbladder demonstrated cholelithiasis without evidence of inflammation. Liver biopsy was completed demonstrating portal and central inflammatory infiltrates that included lymphocytes, plasma cells, and eosinophils, most suggestive of autoimmune hepatitis. The patient was treated with a course of prednisone with improvement in liver function tests. Conclusions: Secondary autoimmune disease is a recognized complication of alemtuzumab that peaks in the third year of therapy. While autoimmune thyroiditis, immune thrombocytopenic purpura, and anti-glomerular basement membrane disease are well known manifestations, other organ involvement can occur, including now a first case of probable treatment-associated autoimmune hepatitis. Disclosure: Dr. Carlson has nothing to disclose. Dr Bozinov has nothing to disclose. Dr. Kipp has nothing to disclose. Dr. Dunn has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Genentech; Sanofi Genzyme; Biogen; Novartis. Dr. Lock has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen; Sanofi Genzyme.