title: Co-occurrence of two cases of progressive multifocal leukoencephalopathy in a natalizumab "infusion group".
abstract: We observed two cases of progressive multifocal leukoencephalopathy (PML) that occurred in the same "infusion group". The group consisted of four patients with relapsing-remitting multiple sclerosis (RRMS) who had been treated with natalizumab (NAT) in the same medical practice for more than four years at the same times and in the same room, raising concerns about viral transmission between members of the infusion group. DNA amplification and sequence comparison of the non-coding control region (NCCR) of JC virus (JCV) present in cerebrospinal fluid (CSF) samples from PML patients #1 and #2 revealed that the amplified JCV sequences differed from the JCV archetype. The NCRR of the viral DNA was unique to each patient, arguing against the possibility of viral transmission between patients. Statistical considerations predict that similar co-occurrences of PML are likely to happen in the future.
authors.affiliation: Institute of Clinical Neuroimmunology, Ludwig-Maximilians-University, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Havla
authors.forename: A
authors.initials: A
authors.lastname: Berthele
authors.forename: T
authors.initials: T
authors.lastname: Kümpfel
authors.forename: M
authors.initials: M
authors.lastname: Krumbholz
authors.forename: A
authors.initials: A
authors.lastname: Jochim
authors.forename: H
authors.initials: H
authors.lastname: Kronsbein
authors.forename: C
authors.initials: C
authors.lastname: Ryschkewitsch
authors.forename: P
authors.initials: P
authors.lastname: Jensen
authors.forename: K
authors.initials: K
authors.lastname: Lippmann
authors.forename: B
authors.initials: B
authors.lastname: Hemmer
authors.forename: E
authors.initials: E
authors.lastname: Major
authors.forename: R
authors.initials: R
authors.lastname: Hohlfeld
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007577:JC Virus / Q000235:genetics; D007968:Leukoencephalopathy, Progressive Multifocal / Q000150:complications* / Q000635:transmission / Q000821:virology; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000821:virology; D000069442:Natalizumab; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab
keywords: JC virus; Natalizumab; PML; multiple sclerosis; progressive multifocal leukoencephalopathy