Two cases of anaphylactic shock by methylprednisolone in neuromyelitis optica

Area of Science:

• Neurology
• Immunology
• Pharmacology

Background:

• Neuromyelitis Optica (NMO) is a severe autoimmune disorder affecting the central nervous system.
• Methylprednisolone (mPSL) succinate ester pulse therapy is a standard treatment for NMO exacerbations.
• Anaphylaxis is a rare adverse event associated with various medications, but not previously reported with mPSL succinate ester in NMO.

Observation:

• Two patients with NMO and concurrent systemic lupus erythematosus developed anaphylactic shock during mPSL succinate ester pulse therapy.
• Both patients had a history of receiving mPSL succinate ester without prior adverse reactions.
• The development of anaphylaxis occurred after multiple treatment courses.

Findings:

• This report documents the first known cases of anaphylactic shock induced by mPSL succinate ester pulse therapy in NMO patients.
• Repeated exposure to mPSL succinate ester and the presence of comorbid autoimmune diseases, such as systemic lupus erythematosus, may increase the risk of anaphylaxis.
• Humoral autoimmune responses might play a role in the hypersensitivity reaction.

Implications:

• Clinicians should be vigilant for potential anaphylaxis in NMO patients undergoing mPSL succinate ester pulse therapy, especially those with other autoimmune conditions.
• Consideration of alternative corticosteroid formulations lacking succinate esters is recommended to mitigate anaphylaxis risk.
• Further research into the mechanisms of corticosteroid-induced anaphylaxis in autoimmune diseases is warranted.