Newly Emerging Type B Insulin Resistance During Treatment With Eculizumab for AQP4-IgG-Positive Neuromyelitis Optica Spectrum Disorder: Fatal Outcome

The document discusses a case where a female patient with Aquaporin-4 immunoglobulin G (AQP4-IgG) antibody-positive neuromyelitis optica spectrum disorders (NMOSD) developed fatal septic complications after developing Type B insulin resistance (TBIR) during treatment with Eculizumab (ECU). The patient initially stabilized with ECU treatment, but developed TBIR 8 months into therapy. Despite further treatment, she was admitted with severe pneumonia and hypoglycemia, and died from sepsis-related multiorgan failure 18 months after starting ECU. The document concludes that TBIR should be considered in NMOSD patients with disturbed glucose metabolism, and calls for more data on the risk/benefit ratio of ECU treatment in patients with co-existing autoimmune comorbidities that may compromise immune function.