Exploring the Relationship Between Ibrutinib Therapy and Neuromyelitis Optica Spectrum Disorders: A case report

Female, 58 yo, diagnosed with CLL in 2021 and has been undergoing Ibrutinib therapy, since then, experienced paresthesia and dysesthesia in her lower limbs in May 2023, accompanied by sensory disturbance. Furthermore encountered muscle weakness in her lower limbs and right upper limb, leading to difficulties in mobility and urinary retention. Subsequently, she was admitted to the hospital in July 2023 for comprehensive examinations including laboratory tests, infectious screenings, autoimmune assessments, imaging studies, cerebrospinal fluid (CSF) analysis, serological tests, and blood cultures. She was diagnosed with longitudinal transverse myelitis (TM) and commenced pulse therapy with corticosteroids, exhibiting partial improvement before being discharged for further outpatient investigation. Presently, she exhibits paraparesis with indications of pyramidal release. In January 2024, her serum tested positive for anti-aquaporin 4 antibodies at a titer of 1/10, confirming the diagnosis of neuromyelitis optica spectrum disorders (NMOSD), leading to the initiation of Rituximab treatment. Discussion: NMOSD is an autoimmune disease that primarily affects the optic nerves and the spinal cord. It is characterized by recurrent attacks of inflammation in the optic nerves and the spinal cord. Ibrutinib is a medication used in the treatment of certain types of cancer, acting through the inhibition of Bruton's tyrosine kinase (BTK), which plays a key role in B-cell signaling. By inhibiting BTK, ibrutinib reduces the production of certain immune cells. Therefore, it is important to recognize that ibrutinib may have effects on the immune system. Conclusion: Ibrutinib, like any medication affecting the immune system, can influence the development or progression of NMOSD. There is no conclusive evidence establishing a direct relationship between its use and the development of the disease. Therefore, if a patient experiences symptoms suggestive of NMOSD, it is essential to recognize the risk and perform appropriate tests.