Ofatumumab Associated Legionella Pneumonia in a Young Multiple Sclerosis Patient
Abstract
Abstract Ofatumumab is the only anti-CD20 IgG1κ human monoclonal antibody therapy for relapsing forms of multiple sclerosis (MS) that patients can self-administer subcutaneously. Anti-CD20 agents are biologic therapies that carry an increased risk of serious infections, but rarely Legionellosis. We present the case of a young man taking ofatumumab for his MS who developed Legionella pneumoniae pneumonia. A 30-year-old man with MS diagnosed two years prior, stable on ofatumumab, presented with fevers, cough, and hemoptysis. A week earlier, he developed fevers and myalgias after administering ofatumumab, but these symptoms persisted longer than usual. Though initial vital signs were normal, he appeared ill and clammy and had bilateral rhonchi on pulmonary auscultation. There was leukocytosis and an elevated procalcitonin level. A chest radiograph showed extensive opacification of the left upper and lower lobes. Treatment with ceftriaxone and azithromycin was initiated. Overnight, he developed a high fever to 40.3 Celsius and treatment was broadened to piperacillin-tazobactam. Sputum culture and urine antigen tests for Legionella and Streptococcus pneumonia were negative. Days later he became hypoxemic, and a computed tomography scan was obtained showing diffuse ground glass opacities. Bronchoscopy was ultimately performed, ultimately revealing a positive Legionella nuclear amplification antibody test, though sputum cultures remained negative. He was treated with levofloxacin…
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