title: Progressive neurologic dysfunction in a psoriasis patient treated with dimethyl fumarate.
abstract: Progressive multifocal leukoencephalopathy (PML) has recently been described in psoriasis or multiple sclerosis patients treated with fumaric acid esters (fumarates), who had developed severe and long-standing lymphocytopenia (<500/mm(3) ). We report a psoriasis patient who presented with progressive neurologic dysfunction and seizures after 2.5 years of fumarate therapy. Despite absolute lymphocyte counts remaining between 500-1000/mm(3) , his CD4(+) and CD8(+) T-cell counts were markedly low. MRI showed right hemispheric and brainstem lesions and JC virus DNA was undetectable in his cerebrospinal fluid. Brain biopsy revealed typical features of PML as well as JC virus-infected neurons. Clinicians should consider PML in the differential diagnosis of fumarate-treated patients presenting with brain lesions or seizures even in the absence of severe lymphocytopenia.
authors.affiliation: Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Bartsch
authors.affiliation: Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany.
authors.forename: Torge
authors.initials: T
authors.lastname: Rempe
authors.affiliation: Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: Wrede
authors.affiliation: Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany.|Neuroimmunology Unit Institute of Clinical Chemistry, University Hospital of Schleswig-Holstein, Kiel, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Leypoldt
authors.affiliation: Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Brück
authors.affiliation: Institute for Virology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Ortwin
authors.initials: O
authors.lastname: Adams
authors.affiliation: Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Kiel, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Rohr
authors.affiliation: Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Kiel, Germany.
authors.forename: Olav
authors.initials: O
authors.lastname: Jansen
authors.affiliation: Division of Neuroimmunology, Department of Neurology, Center for Virology and Vaccine Research, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Christian
authors.initials: C
authors.lastname: Wüthrich
authors.affiliation: Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany.
authors.forename: Günther
authors.initials: G
authors.lastname: Deuschl
authors.affiliation: Division of Neuroimmunology, Department of Neurology, Center for Virology and Vaccine Research, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Igor J
authors.initials: IJ
authors.lastname: Koralnik
mesh_terms: D000368:Aged; D003879:Dermatologic Agents / Q000009:adverse effects; D000069462:Dimethyl Fumarate / Q000009:adverse effects*; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced* / Q000175:diagnosis*; D008297:Male; D011565:Psoriasis / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D003879:Dermatologic Agents; D000069462:Dimethyl Fumarate