SEVERE CUTANEOUS CANDIDA INFECTION DURING NATALIZUMAB THERAPY IN MULTIPLE SCLEROSIS

Natalizumab is a humanized monoclonal antibody against alpha-4 integrin. It prevents inflammatory cells from crossing vascular endothelial cells into the CNS and mucosal organs.1 Natalizumab is approved for the treatment of relapsing multiple sclerosis (MS).2 There are reports of opportunistic infections that can limit its use.3 The diploid fungus Candida albicans may cause opportunistic cutaneous infections, with an estimated prevalence of 0.2% in a healthy European population4 and 3.7% in a sample of immunocompromised patients.5 Severe cutaneous Candida infections may occur in immunocompromised patients, such as those with HIV, chemotherapy, cancer, or organ transplantation.5 We report a 61-year-old woman with relapsing MS who presented with a severe cutaneous Candida infection during treatment with natalizumab. ### Level of evidence. This is a single case report of severe adverse event. It is level IV evidence. ### Case report. In August 2008, a 61-year-old woman with MS developed an itchy redness in her inguinal, genital, axillary, and lumbar regions, a few days after her 11th natalizumab infusion. This was diagnosed as cutaneous Candida infection. Within 14 days, over 30% of her body surface was covered by Candida , with multiple ulcerations in the infected gluteal region. In August 2007, the patient had been diagnosed with relapsing-remitting MS with an Expanded Disability Status Scale score of 5.5. …