Tocilizumab-Associated Reversible Cerebral Vasoconstriction: A Case Report

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¹Department of Neurology & Instituto de Investigación Sanitaria La Princesa, Hospital Universitario de la Princesa, Madrid, Spain.

|January 18, 2019

Abstract

Objectives:

To report a case of reversible cerebral vasoconstriction syndrome (RCVS) possibly precipitated by tocilizumab.

Background:

Immunosuppressant drugs are a rare cause of reversible cerebral vasoconstriction, a syndrome characterized by segmental vasospasm. However, although it is considered a reversible process that resolves within 3 months, the cerebral vasoconstriction over time may lead to severe complications such as strokes.

Results:

We describe a 53-year-old woman who presented with a reversible vasoconstriction syndrome possibly associated with tocilizumab, an inhibitor of IL-6 receptor used in inflammatory diseases such as rheumatoid arthritis. The patient developed a cerebellar infarction as the major complication of the vasoconstriction syndrome.

Conclusion:

Tocilizumab could be a trigger of RCVS. It is important to bear in mind the role of tocilizumab as a possible precipitating factor in order to remove it and reduce complications such as strokes. It is, to our knowledge, the first reversible vasoconstriction syndrome possibly precipitated by tocilizumab published to date.

Keywords:

adverse drug reaction (ADR)immunosuppressant drugs reversible cerebral vasoconstriction syndrome (RCVS)tocilizumab (IL-6 inhibitor)vasospasm

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