JC virus granule cell neuronopathy and GCN-IRIS under natalizumab treatment

Ann Neurol. 2013 Oct;74(4):622-6. doi: 10.1002/ana.23973. Epub 2013 Sep 16.


Progressive multifocal leukoencephalopathy is the most common clinical presentation of JC virus (JCV)-associated central nervous system (CNS) disease and has emerged as a major safety concern in multiple sclerosis patients treated with the monoclonal antibody natalizumab. Here we report clinical, radiological, and histological findings of a case of cerebellar granule cell neuronopathy (GCN), a JCV-associated CNS disease, so far unreported amongst patients treated with natalizumab. GCN should be considered as a JCV CNS manifestation in patients with newly developed, progressive cerebellar signs under natalizumab treatment, especially in cases where cerebellar atrophy can be visualized by magnetic resonance imaging.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Antigens, CD / metabolism
  • Brain / pathology
  • Brain / virology
  • Female
  • Humans
  • Immune Reconstitution Inflammatory Syndrome / etiology*
  • Immune Reconstitution Inflammatory Syndrome / pathology
  • Immune Reconstitution Inflammatory Syndrome / virology
  • JC Virus / physiology*
  • Leukoencephalopathy, Progressive Multifocal / complications*
  • Leukoencephalopathy, Progressive Multifocal / drug therapy*
  • Magnetic Resonance Imaging
  • Natalizumab
  • Spinocerebellar Degenerations / drug therapy
  • Spinocerebellar Degenerations / etiology*


  • Antibodies, Monoclonal, Humanized
  • Antigens, CD
  • Natalizumab