Progressive multifocal leukoencephalopathy after natalizumab monotherapy.
case_report · Level V
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- Record sourced from PubMed, PMID 19741229.
- Also identified by DOI 10.1056/NEJMoa0810316.
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Abstract
We describe progressive multifocal leukoencephalopathy (PML) caused by infection with human polyomavirus JC virus in a patient with multiple sclerosis who was treated with natalizumab. The first PML symptoms appeared after 14 monthly infusions of the drug. Magnetic resonance imaging (MRI) showed a presumed multiple sclerosis lesion, and JC virus DNA was not detected on polymerase-chain-reaction (PCR) assay of cerebrospinal fluid. The patient's symptoms worsened, and the diagnosis of PML was established with a more sensitive quantitative PCR assay after 16 infusions of natalizumab. Plasma exchange was used to accelerate clearance of natalizumab. Approximately 3 weeks after plasma exchange, an immune-reconstitution inflammatory syndrome appeared. JC virus DNA was no longer detectable on quantitative PCR assay, and the patient's symptoms improved.
Medical subject headings
- Adult
- Antibodies, Monoclonal
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Brain
- Brain/pathology
- DNA, Viral
- DNA, Viral/blood
- Humans
- Immune Reconstitution Inflammatory Syndrome
- Immune Reconstitution Inflammatory Syndrome/etiology
- Integrin alpha4
- Integrin alpha4/immunology
- JC Virus
- JC Virus/genetics
- JC Virus/immunology
- Leukoencephalopathy, Progressive Multifocal
- Leukoencephalopathy, Progressive Multifocal/chemically induced
- Leukoencephalopathy, Progressive Multifocal/immunology
- Magnetic Resonance Imaging
- Male
- Multiple Sclerosis
- Multiple Sclerosis/complications
- Multiple Sclerosis/drug therapy
- Multiple Sclerosis/pathology
- Natalizumab
- Polymerase Chain Reaction