Objective:

To document a previously unreported case of N.sicca sepsis associated with ravulizumab in a patient with myasthenia gravis (MG).

Background:

As novel therapeutics emerge such as the complement-based inhibitor ravulizumab, diligent post-marketing surveillance is important as these agents put patients at greater risk of encapsulated bacterial infections. We present a case report of a generalized myasthenia gravis (MG) patient on ravulizumab who suffered serious N. sicca bacteremia while on this complement modulator.  

Design/Methods:

NA

Results:

This patient had serum anti-AchR antibody positive generalized MG. He was on active treatment with ravulizumab q8 week infusions, azathioprine 100mg, prednisone 2.5mg and pyridostygmine 60mg three times a day. He was hospitalized for an acute febrile illness, with blood cultures x 2 positive for N. sicca. He was treated with antimicrobials including IV ceftriaxone for 14 days. No identifiable source for infection was identified. 

Conclusions:

This case demonstrates that in addition to increasing risk of meningococcal infection, for which patients receiving complement inhibitors are pre-vaccinated, these agents also pose risk of other encapsulated bacterial infections, for which protection is not available.