Reversible therapy-related dysplastic hematopoiesis following Beta Interferon Therapy in Multiple Sclerosis Patients: Report of 2 Cases
A 39-year-old woman suffering from acute paresis of the right lower limb was referred to our clinic for evaluation. She had the symptoms for 8 years and the year before the evaluation, she had an episode of left optic neuritis which had been treated with high dose of steroids. She had recovered completely after 1 month. Neurological examinations revealed diplopia, limb ataxia, dysarthria and fairly clumsy tandem gait.\nGiven her history of two attacks, as well as MRI lesions matching the McDonald criteria for dissemination in space and time, other possibilities were ruled out and she was diagnosed as MS and accordingly, interferon β1b was started for the patient.\nShe had received interferon for 5 years without any significant side effects or unpredictable problems. During this period, she had 4 relapses for which she was treated with methyl prednisone pulse for each relapse. A few months prior to the time of this report, during routine evaluation of the patient, the lab data showed a reduction of WBC, Hb and platelets (WBC: 3000/dl, Hb: 9.8g/dl, PLT: 151/000dl- 2008/4). The interferon was stopped and hematology consultation was performed.\nBone marrow examinations showed dysplastic hematopoiesis, granulocytes displayed reduced segmentation (pseudo-Pelger-Huet abnormality) and reduced granulation.\nThe patient was treated with conservative therapy and gradually all hematologic measures returned to normal levels. The same beta interferon treatment was reintroduced. After more than 1 year of restarting the interferon treatment there were no abnormalities in the blood tests (WBC: 6900dl, Hb: 10g/dl, PLT: 301.000dl- 2010/10).