Progressive multifocal leukoencephalopathy in a patient treated with natalizumab.
We describe the clinical course of a patient with multiple sclerosis in whom progressive multifocal leukoencephalopathy (PML), an opportunistic viral infection of the central nervous system, developed during treatment with interferon beta-1a and a selective adhesion-molecule blocker, natalizumab. The first PML lesion apparent on magnetic resonance imaging was indistinguishable from a multiple sclerosis lesion. Despite treatment with corticosteroids, cidofovir, and intravenous immune globulin, PML progressed rapidly, rendering the patient quadriparetic, globally aphasic, and minimally responsive. Three months after natalizumab therapy was discontinued, changes consistent with an immune-reconstitution inflammatory syndrome developed. The patient was treated with systemic cytarabine, and two months later, his condition had improved.
Langer-Gould
Annette
A
Department of Neurology, Stanford University School of Medicine, Stanford, Calif, USA. annette1@stanford.edu
Atlas
Scott W
SW
Green
Ari J
AJ
Bollen
Andrew W
AW
Pelletier
Daniel
D
D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents / Q000627:therapeutic use; D001037:Aphasia / Q000139:chemically induced; D001259:Ataxia / Q000139:chemically induced; D001921:Brain / Q000473:pathology; D003561:Cytarabine / Q000627:therapeutic use; D006801:Humans; D039441:Integrin alpha4 / Q000276:immunology*; D007577:JC Virus / Q000302:isolation & purification; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000473:pathology; D000069442:Natalizumab; D009894:Opportunistic Infections / Q000139:chemically induced* / Q000473:pathology; D010291:Paresis / Q000139:chemically induced
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D000069442:Natalizumab; D003561:Cytarabine; D039441:Integrin alpha4