title: Progressive multifocal leukoencephalopathy after natalizumab therapy for Crohn's disease.
abstract: The prior diagnosis of fatal astrocytoma in a 60-year-old man with Crohn's disease treated with natalizumab, a monoclonal antibody against alpha4 integrins, was reclassified as JC virus-related progressive multifocal leukoencephalopathy (PML). Analysis of frozen serum samples showed that JC virus DNA had appeared in the serum three months after the initiation of open-label natalizumab monotherapy and two months before the appearance of symptomatic PML. There was staining of the brain lesion for polyomavirus. This case report, along with two others, suggests that anti-alpha4-integrin therapy can result in JC virus-induced PML.
authors.affiliation: Division of Gastroenterology, University of Leuven Hospitals, Leuven, Belgium.
authors.forename: Gert
authors.initials: G
authors.lastname: Van Assche
authors.forename: Marc
authors.initials: M
authors.lastname: Van Ranst
authors.forename: Raf
authors.initials: R
authors.lastname: Sciot
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Dubois
authors.forename: Séverine
authors.initials: S
authors.lastname: Vermeire
authors.forename: Maja
authors.initials: M
authors.lastname: Noman
authors.forename: Jannick
authors.initials: J
authors.lastname: Verbeeck
authors.forename: Karel
authors.initials: K
authors.lastname: Geboes
authors.forename: Wim
authors.initials: W
authors.lastname: Robberecht
authors.forename: Paul
authors.initials: P
authors.lastname: Rutgeerts
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D001254:Astrocytoma / Q000175:diagnosis; D001921:Brain / Q000473:pathology / Q000821:virology; D001932:Brain Neoplasms / Q000175:diagnosis; D003424:Crohn Disease / Q000188:drug therapy*; D004279:DNA, Viral / Q000097:blood; D003951:Diagnostic Errors; D017809:Fatal Outcome; D005838:Genotype; D006801:Humans; D039441:Integrin alpha4 / Q000276:immunology*; D007577:JC Virus / Q000235:genetics / Q000302:isolation & purification; D007958:Leukocyte Count; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D000069442:Natalizumab; D009894:Opportunistic Infections / Q000139:chemically induced* / Q000473:pathology; D019562:Viral Load
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D004279:DNA, Viral; D000069442:Natalizumab; D039441:Integrin alpha4