Treatment of progressive multifocal leukoencephalopathy associated with natalizumab

N Engl J Med. 2009 Sep 10;361(11):1075-80. doi: 10.1056/NEJMoa0810257.


We describe the clinical and therapeutic course of a 52-year-old patient with multiple sclerosis in whom progressive multifocal leukoencephalopathy (PML) developed after 12 months of therapy with natalizumab. The patient was hospitalized 2 months after the onset of neurologic and psychiatric symptoms and was treated with plasma exchange and immunoadsorption to eliminate natalizumab. After a brief improvement, he became critically ill with an apparent episode of immune reconstitution inflammatory syndrome. Steroid-pulse therapy led to stabilization of the patient's condition and clinically significant recovery. This case illustrates that prompt diagnosis and treatment may improve the outcome in patients with severe PML associated with natalizumab therapy.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized
  • Brain / pathology
  • Humans
  • Immunosorbent Techniques
  • Integrin alpha4 / immunology
  • JC Virus*
  • Leukoencephalopathy, Progressive Multifocal / chemically induced
  • Leukoencephalopathy, Progressive Multifocal / therapy*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Multiple Sclerosis / complications
  • Multiple Sclerosis / drug therapy*
  • Multiple Sclerosis / pathology
  • Natalizumab
  • Plasma Exchange*


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Natalizumab
  • Integrin alpha4