Treatment of progressive multifocal leukoencephalopathy associated with natalizumab.
We describe the clinical and therapeutic course of a 52-year-old patient with multiple sclerosis in whom progressive multifocal leukoencephalopathy (PML) developed after 12 months of therapy with natalizumab. The patient was hospitalized 2 months after the onset of neurologic and psychiatric symptoms and was treated with plasma exchange and immunoadsorption to eliminate natalizumab. After a brief improvement, he became critically ill with an apparent episode of immune reconstitution inflammatory syndrome. Steroid-pulse therapy led to stabilization of the patient's condition and clinically significant recovery. This case illustrates that prompt diagnosis and treatment may improve the outcome in patients with severe PML associated with natalizumab therapy.
Wenning
Werner
W
Neurological Clinic, Ortenau-Klinikum, Offenburg, Germany.
Haghikia
Aiden
A
Laubenberger
Jörg
J
Clifford
David B
DB
Behrens
Peter F
PF
Chan
Andrew
A
Gold
Ralf
R
D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D001921:Brain / Q000473:pathology; D006801:Humans; D007163:Immunosorbent Techniques; D039441:Integrin alpha4 / Q000276:immunology; D007577:JC Virus; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D000069442:Natalizumab; D010951:Plasma Exchange
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab; D039441:Integrin alpha4