title: Successful management of natalizumab-associated progressive multifocal leukoencephalopathy and immune reconstitution syndrome in a patient with multiple sclerosis.
abstract: OBJECTIVE
  To describe a case of successful clinical management of natalizumab-associated progressive multifocal leukoencephalopathy (PML) and immune reconstitution syndrome (IRIS) in a patient with multiple sclerosis.
  
  
  METHODS
  Case report.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A 41-year-old woman with relapsing-remitting multiple sclerosis developed PML after 29 natalizumab infusions.
  
  
  METHODS
  Immediate plasma exchange was combined for removal of natalizumab with application of mefloquine and mirtazapine to limit viral replication and oligodendrocyte infection. A subsequent IRIS was treated with glucocorticosteroids.
  
  
  RESULTS
  After 3 months of treatment, cerebrospinal fluid tested negative for JC virus. There was a favorable outcome, and the Expanded Disability Status Scale score remained stable at 3.5 compared with before PML.
  
  
  CONCLUSIONS
  In the setting of early diagnosis and consequent treatment, natalizumab-associated PML can be well managed in some cases. This situation differs from the course of PML in other conditions, eg, after the application of depleting monoclonal antibodies, in which irreversible cellular effects are associated with very high mortality.
authors.affiliation: Department of Neurology, St Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Schröder
authors.forename: De-Hyung
authors.initials: DH
authors.lastname: Lee
authors.forename: Kerstin
authors.initials: K
authors.lastname: Hellwig
authors.forename: Carsten
authors.initials: C
authors.lastname: Lukas
authors.forename: Ralf A
authors.initials: RA
authors.lastname: Linker
authors.forename: Ralf
authors.initials: R
authors.lastname: Gold
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D001921:Brain / Q000473:pathology* / Q000821:virology; D005260:Female; D006801:Humans; D007577:JC Virus; D007968:Leukoencephalopathy, Progressive Multifocal / Q000209:etiology / Q000628:therapy* / Q000821:virology; D008279:Magnetic Resonance Imaging; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D000069442:Natalizumab; D010951:Plasma Exchange
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab