title: Clinically silent PML and prolonged immune reconstitution inflammatory syndrome in a patient with multiple sclerosis treated with natalizumab.
abstract: We report the case of a woman with natalizumab-treated multiple sclerosis (MS) and clinically silent progressive multifocal leukoencephalopathy (PML) with an unusually long preclinical phase, followed by acute symptoms due to development of immune reconstitution inflammatory syndrome (IRIS). Furthermore, the course of the IRIS was prolonged and continued to progress even five months after natalizumab treatment was ceased. This case shows that PML and IRIS can have a considerably variable course in natalizumab-treated MS patients and underlines the need for PML screening in JC virus antibody-positive patients in order to detect clinically silent cases.
authors.affiliation: Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark. blink@dadlnet.dk
authors.forename: Morten
authors.initials: M
authors.lastname: Blinkenberg
authors.forename: Finn
authors.initials: F
authors.lastname: Sellebjerg
authors.forename: Anne-Mette
authors.initials: AM
authors.lastname: Leffers
authors.forename: Camilla Gøbel
authors.initials: CG
authors.lastname: Madsen
authors.forename: Per Soelberg
authors.initials: PS
authors.lastname: Sørensen
mesh_terms: D000230:Adenocarcinoma / Q000150:complications; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000150:complications; D002531:Cerebellum / Q000473:pathology; D005260:Female; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D007577:JC Virus; D007968:Leukoencephalopathy, Progressive Multifocal / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D000069442:Natalizumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab
keywords: IRIS; PML; multiple sclerosis; natalizumab