B cell suppressive therapy led to a delayed diagnosis of Lyme disease

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I will be discussing a 20-year-old girl with a 3 year history of multiple sclerosis treated with B cell suppressive therapy . She was prescribed two biological disease-modifying antirheumatic drug (DMARD).

This article was written by Sjowall and colleagues in the journal Frontiers in Neurology.

She was initially prescribed tocilizumab, marketed in the US as Actemra.   Tocilizumab is a monoclonal antibody blocks signals from IL-6 receptors them, is a monoclonal antibody against the interleukin-6 receptor. Tocilizumab can lower the ability of your immune system to fight infections.

She was subsequently prescribed rituximab, sold under the brand name Rituxan, another B- cell treatment.

She suffered for 6 months with knee arthritis and a persistent rash. Lyme disease was considered by dismissed at the Lyme disease tests were negative.

She was finally treated 6 months after the fact with doxyc ycline.

1.         Sjowall J, Xirotagaros G, Anderson CD, Sjowall C, Dahle C. Case Report: Borrelia-DNA Revealed the Cause of Arthritis and Dermatitis During Treatment With Rituximab. Front Neurol. 2021;12:645298 .

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Dr. Cameron is a Lyme disease expert and the author “Inside Lyme: An expert’s guide to the science of Lyme disease.” He has been treating adolescents and adults for more than 30 years.

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