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Disseminated Gonococcal Infection Associated with Eculizumab Therapy for Paroxysmal Nocturnal Hemoglobinuria: A Case Report and Literature Review

Authors Saito M, Harada S, Ogasawara R, Izumiyama K, Mori A, Morioka M, Kondo T

Received 24 March 2020

Accepted for publication 3 July 2020

Published 16 July 2020 Volume 2020:13 Pages 403—406


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Makoto Saito, Shinpei Harada, Reiki Ogasawara, Koh Izumiyama, Akio Mori, Masanobu Morioka, Takeshi Kondo

Department of Internal Medicine and Hematology, Blood Disorders Center, Aiiku Hospital, Sapporo, Japan

Correspondence: Makoto Saito Email

Abstract: Eculizumab has been developed as a breakthrough treatment for paroxysmal nocturnal hemoglobinuria (PNH). Not only for breakthroughs, eculizumab therapy is also known to increase the risk of invasive meningococcal infection. It has also been recently reported that, although rarely, administration of eculizumab may result in disseminated gonococcal infection (DGI). We report here a case in which a young patient who had used eculizumab for PNH developed DGI. A 22-year-old Japanese male with PNH who had been treated with eculizumab complained of high fever, mild nausea, headache and right knee joint pain. The patient was admitted and suspected to have sepsis due to meningococcal infection and began to receive ceftriaxone (CTRX). Gonococci were detected in a venous blood culture a few days later, and this case was diagnosed as DGI. CTRX was effective, and the patient was discharged. However, four weeks later, he complained of the same subjective symptoms as at the beginning and was hospitalized again. The presence of gonococcus was proven by venous blood culture, CTRX was re-administered and the patient responded. After discharge, he was counseled on safer sexual activity, including accurate and consistent use of condoms, by urologists. He has not relapsed with DGI for more than one year. When serious signs of infection occur in patients receiving eculizumab, it is recommended to consider DGI as well as invasive meningococcal infection, and CTRX should be given.

Keywords: disseminated gonococcal infection, DGI, eculizumab, paroxysmal nocturnal hemoglobinuria, PNH, ceftriaxone

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