Dados do Trabalho

Título

Pulmonary embolism in a patient with multiple sclerosis during the treatment with teriflunomide: a case report

RESUMO

Case presentation: A 44-year-old woman, former smoker, was previously diagnosed with relapsing-remitting multiple sclerosis (RRMS) and had been receiving interferon beta-1a over the past five years, with no signs of disease activity since the beginning of treatment. Due to the development of flu-like symptoms and poor adherence to the medication, she was switched to teriflunomide (TFN). After one month of treatment with TFN, the patient reported a new-onset right-sided lumbar pain and dyspnea. At the occasion, chest CT angiography showed signs of embolism in the inferior segmental pulmonary arteries, as well as pulmonary infarction in the right lower lobe. The patient was, then, started on rivaroxaban and presented significant improvement of the symptoms over the following weeks. TFN was discontinued and the patient maintained the initial Expanded Disability Status Scale (EDSS) of 2.5. Echocardiogram showed no signs of pulmonary hypertension.
Discussion: TFN is an oral immunomodulator and a disease modifying therapy for patients with RRMS. Although liver toxicity is the most frequent concern during the treatment with this medication, scarce reports of pulmonary embolism (PE) are present in the literature. Thrombotic and thromboembolic events have been described in clinical trials evaluating TFN for RRMS, with the group receiving TFN having a slightly, but not significantly higher, incidence compared to the placebo group (1.7% vs. 1%). Here, we report the case of a patient that developed PE approximately one month after the beginning of treatment with TFN. Despite the non-significant higher incidence, given the potential association between the use of TFN and development of PE, clinicians should be aware of this serious condition in the follow-up of this set of patients.
Final comments: The case presented demonstrates a rare association between the treatment of RRMS with teriflunomide and the development of pulmonary embolism. Although liver toxicity is the most frequent concern, scarce reports of PE are present in the literature and should be considered as a differential diagnosis when evaluating a patient with new-onset respiratory symptoms during the treatment with TFN.

Palavras Chave

Pulmonary embolism; multiple sclerosis; teriflunomide

Área

Neuroimunologia