{
  "abstract": "Complement inhibition is a highly effective strategy for preventing relapse and disability accumulation in neuromyelitis optica spectrum disorder (NMOSD). Invasive infection with Neisseria meningitidis, the principal risk of complement inhibition, is largely mitigated by adequate vaccination. However, vaccination in the context of treatment sequencing from other immunosuppressive therapies, in particular rituximab, presents unique challenges. We present a 17-year-old woman with a severe NMOSD relapse despite B-cell depletion, who subsequently developed meningococcal sepsis after treatment with ravulizumab, despite prior vaccination; and we propose strategies to manage risk in this patient population.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia"
      ],
      "name": "Katharine Kline"
    },
    {
      "affiliations": [
        "Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia"
      ],
      "name": "Alexandra Raleigh"
    },
    {
      "affiliations": [
        "Department of Neurology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia",
        "Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia"
      ],
      "name": "Heidi Beadnall"
    },
    {
      "affiliations": [
        "Department of Neurology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia"
      ],
      "name": "Judith M Spies"
    },
    {
      "affiliations": [
        "Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia"
      ],
      "name": "Elizabeth Thompson"
    },
    {
      "affiliations": [
        "Department of Immunology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia",
        "Institute of Academic Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia",
        "Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia"
      ],
      "name": "Nicolas Urriola"
    },
    {
      "affiliations": [
        "Department of Immunology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia",
        "Institute of Academic Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia",
        "Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia"
      ],
      "name": "Stephen Adelstein"
    },
    {
      "affiliations": [
        "Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia",
        "Department of Neurology and Neuroscience, University of Freiburg, Freiburg, BW, Germany"
      ],
      "name": "Heinz Wiendl"
    },
    {
      "affiliations": [
        "Department of Neurology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia",
        "Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia"
      ],
      "name": "Michael Barnett"
    }
  ],
  "title": "Ravulizumab-related meningococcal sepsis post rituximab",
  "uid": "4f0dd7ab-1186-5a71-8bfc-dc2ac1810cfc"
}