Progressive multifocal leukoencephalopathy after natalizumab therapy for Crohn's disease.
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.
Van Assche
Gert
G
Division of Gastroenterology, University of Leuven Hospitals, Leuven, Belgium.
Van Ranst
Marc
M
Sciot
Raf
R
Dubois
Bénédicte
B
Vermeire
Séverine
S
Noman
Maja
M
Verbeeck
Jannick
J
Geboes
Karel
K
Robberecht
Wim
W
Rutgeerts
Paul
P
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
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D004279:DNA, Viral; D000069442:Natalizumab; D039441:Integrin alpha4