Self-Limited Cytomegalovirus Infection During Natalizumab Treatment for Multiple Sclerosis

Marina Rodrigues Lima; Luís Arthur Brasil Gadelha Farias; Maycon Fellipe da Ponte; Luís Edmundo Teixeira de Arruda Furtado

doi:10.12890/2019_001046

Self-Limited Cytomegalovirus Infection During Natalizumab Treatment for Multiple Sclerosis

Eur J Case Rep Intern Med. 2019 Feb 1;6(2):001046. doi: 10.12890/2019_001046. eCollection 2019.

Authors

Marina Rodrigues Lima¹, Luís Arthur Brasil Gadelha Farias², Maycon Fellipe da Ponte³, Luís Edmundo Teixeira de Arruda Furtado³

Affiliations

¹ Faculty of Medicine, University Center UNINTA, Sobral, Ceará, Brazil.
² Faculty of Medicine, Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil.
³ Internal Medicine Department, Hospital Regional Norte (HRN), Sobral, Ceará, Brazil.

Abstract

Natalizumab is indicated as monotherapy for the treatment of relapsing-remitting multiple sclerosis; it prevents outbreaks and delays the progression of physical disability. Here, we report the case of a 30-year-old patient with multiple sclerosis receiving natalizumab as monotherapy who subsequently developed self-limited cytomegalovirus disease. Cytomegalovirus infection has been reported during treatment with natalizumab, and in this study, we use new techniques to analyze the possible association of cytomegalovirus infection with natalizumab.

Learning points: Natalizumab is a humanized recombinant monoclonal antibody (IgG4k) against α4-integrin which promotes immunocompromise by blocking the adhesion interactions necessary for lymphocyte trafficking.Cytomegalovirus infection has been described during natalizumab treatment, although the pathogenesis and mechanisms are not complete understood.This case highlights the importance of awareness of this association and possible complications.

Keywords: Infection; cytomegalovirus; multiple sclerosis; natalizumab; viruses.