title: Natalizumab-induced progressive multifocal leukoencephalopathy.
abstract: A 55-year-old woman with known relapsing-remitting multiple sclerosis (RRMS) on natalizumab (Tysabri®) for 3 years was admitted to the hospital with worsening word-finding difficulties and gait instability. Neurologic examination revealed right hemianopia, right arm hemiplegia, right-sided sensory loss, and global aphasia. The patient underwent MRI and PET imaging with concurrent electroencephalogram. She was subsequently diagnosed with natalizumab-induced progressive multifocal leukoencephalopathy (PML) and treated with plasmapheresis, intravenous immunoglobulin, and high-dose intravenous steroids. Steroids were continued over a 3-month hospital course and tapered upon discharge. Speech, arm strength, and ambulation have since improved.
authors.affiliation: From the Department of *Radiology; and †Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Ashesh A
authors.initials: AA
authors.lastname: Thaker
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Schmitt
authors.forename: John R
authors.initials: JR
authors.lastname: Pollard
authors.forename: Jacob G
authors.initials: JG
authors.lastname: Dubroff
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced* / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D000069442:Natalizumab; D049268:Positron-Emission Tomography
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab