Successful management of natalizumab-associated progressive multifocal leukoencephalopathy and immune reconstitution syndrome in a patient with multiple sclerosis.
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.
Schröder
Alexandra
A
Department of Neurology, St Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.
Lee
De-Hyung
DH
Hellwig
Kerstin
K
Lukas
Carsten
C
Linker
Ralf A
RA
Gold
Ralf
R
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
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab