title: Natalizumab and HSV meningitis.
abstract: Natalizumab (Tysabri, Biogen Idec and Elan Pharmaceuticals) is a monoclonal antibody approved for use in patients with relapsing multiple sclerosis (MS) as well as moderate to severe Crohn's disease. We report the first case of a patient with a history of MS, on monthly natalizumab, who developed HSV-2 meningitis. We discuss the mechanism of action of natalizumab and review what is known about the reactivation of herpes infection in association with this medication. The question of herpes simplex virus (HSV) and varicella zoster virus (VZV) prophylaxis for patients is raised.
authors.affiliation: Division of Infectious Diseases, Massachusetts General Hospital, Gray-Jackson 504, 55 Fruit Street, Boston, MA 02114, USA. eseiguershenoy@partners.org
authors.forename: Erica Seiguer
authors.initials: ES
authors.lastname: Shenoy
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Mylonakis
authors.forename: Rocio M
authors.initials: RM
authors.lastname: Hurtado
authors.forename: Nagagopal
authors.initials: N
authors.lastname: Venna
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000075202:Contraindications; D003424:Crohn Disease / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D005260:Female; D006561:Herpes Simplex / Q000139:chemically induced* / Q000276:immunology / Q000821:virology; D018258:Herpesvirus 2, Human / Q000276:immunology; D014645:Herpesvirus 3, Human / Q000276:immunology; D006801:Humans; D039441:Integrin alpha4 / Q000276:immunology / Q000378:metabolism; D008213:Lymphocyte Activation / Q000187:drug effects; D008214:Lymphocytes / Q000276:immunology / Q000473:pathology / Q000821:virology; D008587:Meningitis, Viral / Q000139:chemically induced* / Q000276:immunology / Q000821:virology; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D000069442:Natalizumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab; D039441:Integrin alpha4