Presumptive progressive multifocal leukoencephalopathy in multiple sclerosis after natalizumab therapy

J Neuroimaging. Jul-Aug 2014;24(4):425-8. doi: 10.1111/jon.12010. Epub 2013 Jan 16.

Abstract

Background and purpose: To describe a patient with relapsing remitting MS who was treated with natalizumab for 36 months. First symptoms of presumptive progressive multifocal leukoencephalopathy (PML) appeared 14 weeks after her last natalizumab infusion.

Methods: Neurological examination, MRI and CSF analysis were performed.

Results: The lack of anti-inflammatory treatment response, clinical course, and serial MRI examinations showed lesion development typical for PML on diffusion-weighted and FLAIR MRI. CSF analysis for JC virus was tested negative twice.

Conclusions: This case represents a presumptive PML after discontinuation of natalizumab treatment-similar to the definition established for PML in HIV patients.

Keywords: Progressive multifocal leukoencephalopathy; multiple sclerosis; natalizumab.

Publication types

  • Case Reports

MeSH terms

  • Anti-Inflammatory Agents / adverse effects
  • Anti-Inflammatory Agents / therapeutic use
  • Antibodies, Monoclonal, Humanized / adverse effects*
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Brain / drug effects
  • Brain / pathology*
  • Female
  • Humans
  • Leukoencephalopathy, Progressive Multifocal / chemically induced*
  • Leukoencephalopathy, Progressive Multifocal / pathology*
  • Magnetic Resonance Imaging / methods*
  • Middle Aged
  • Multiple Sclerosis
  • Natalizumab

Substances

  • Anti-Inflammatory Agents
  • Antibodies, Monoclonal, Humanized
  • Natalizumab