Soliris eases woman’s disease symptoms after flu triggers aHUS
56-year-old was taking medication for multiple myeloma
Soliris (eculizumab) helped ease disease symptoms for a woman with multiple myeloma who developed atypical hemolytic uremic syndrome (aHUS) as a complication of a viral infection caused by H1N1 influenza — also known as influenza A, or swine flu.
“The prompt recognition and initiation of anti-complement therapy played a pivotal role in the successful management and recovery of this patient,” the researchers wrote.
The woman’s case was detailed in a report, “Influenza A H1N1 Triggering Complement-Mediated Hemolytic Uremic Syndrome,” published in the Journal of Medical Cases.
The complement system is a part of the immune system that helps protect the body against infections. In aHUS, the complement system becomes overactive and damages the body’s own cells. This leads to hemolysis (red blood cell destruction) and thrombocytopenia (low platelet counts). Soliris works to block the activity of the complement cascade that drives blood clot formation and related symptoms in aHUS.
While certain infections, including those caused by influenza viruses, can act as a trigger and cause aHUS, this has been rarely reported in adults.
Flu symptoms prompt visit to emergency department
The 56-year-old woman described in the case report had multiple myeloma, a type of blood cancer, and was being treated with the anticancer medications carfilzomib (sold as Kyprolis) and daratumumab (sold as Darzalex), which weakened her immune system. She visited the emergency department after four days of feeling increasingly unwell.
She had body aches, fever, cough, nosebleeds, back pain, and dark-colored urine. She had recently been to a family event after which several others also got sick. Doctors examined her and found she had a blocked nose, and they heard abnormal lung sounds that could indicate blocked airways.
Blood tests showed low levels of hemoglobin — the protein that carries oxygen in red blood cells — and a very low number of platelets. Her creatinine was higher than normal, which can indicate that the kidneys are not functioning well. Liver enzymes were also high, suggesting damage to the liver.
High levels of D-dimers — small protein fragments present in the blood after a clot breaks down — and lactate dehydrogenase — an enzyme released from red blood cells as they are destroyed — pointed to hemolysis. A blood smear examined under a microscope revealed the presence of fragmented red blood cells, called schistocytes.
The woman was admitted to the intensive care unit for close monitoring, as she had a severe case of H1N1 influenza. She received intravenous (into-the-vein) fluids and was started on broad-spectrum antibiotics in case she had pneumonia — a bacterial infection of the lungs — in addition to the viral infection.
By the second day, her hemoglobin levels and platelet counts were even lower. She received a red blood cell transfusion and was started on the antiviral medication oseltamivir (sold as Tamiflu). She had not improved by the following day.
Doctors raised “a strong clinical suspicion” of aHUS and started treatment with Soliris, an approved treatment for aHUS. To reduce the risk of infections, which may occur as a side effect of Soliris, she also received meningococcal vaccines and antibiotics.
She began to improve over the next two days. Hemoglobin levels and platelet counts increased, while creatinine levels started to decline consistent with an improvement in kidney function. Schistocytes were no longer observed in a blood smear. She continued treatment with Soliris weekly after discharge.
Because the woman’s multiple myeloma progressed, her treatment was switched to the anticancer medications venetoclax (sold as Venclexta) and bortezomib (sold as Velcade), in combination with the corticosteroid dexamethasone. She returned to work two months after her hospital stay. After six months of treatment with Soliris, she had experienced no relapse of aHUS.
While rare, “this case emphasizes the importance of maintaining a high index of suspicion for [aHUS] in adults with influenza infection, especially those who are immunocompromised,” the researchers wrote.
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