Severe lymphopenia after subcutaneous cladribine in a patient with multiple sclerosis: To vaccinate or not?

eNeurologicalSci. 2020 Oct 9:21:100279. doi: 10.1016/j.ensci.2020.100279. eCollection 2020 Dec.


Objective: To describe a fatal case of influenza A pneumonia in a patient with severe lymphopenia after receiving subcutaneous cladribine to treat her multiple sclerosis (MS).

Methods: Case report.

Results: A 53-year-old woman developed fatal influenza pneumonia associated with grade 4 lymphopenia two months after receiving a total dose of 60mg subcutaneous cladribine. Despite treatment with oseltamivir, her condition deteriorated and the patient passed away after developing respiratory failure.

Conclusion: Cladribine-related lymphopenia is usually mild to moderate, however severe lymphopenia may occur. People with MS, especially those who are immunosuppressed, should be offered the inactivated influenza vaccine annually.

Keywords: Adverse event; Cladribine; Disease-modifying treatment; Influenza A virus; Lymphopenia; Multiple Sclerosis.

Publication types

  • Case Reports