title: Asymptomatic progressive multifocal leukoencephalopathy during natalizumab therapy with treatment.
abstract: We report a case of asymptomatic progressive multifocal leukoencephalopathy (PML) detected on regular MRI screening in a 40-year-old patient with subsequent benign course with 12 months follow-up. The patient had a history of aggressive inflammatory multiple sclerosis, prior mitoxantrone therapy, Stratify John Cunningham Virus test positivity (Quest Diagnostics, Madison, NJ, USA), and 5 years of natalizumab monotherapy. The initial MRI detection of PML was both atypical and subtle. Early diagnosis and intervention, and pre-emptive treatment for immune reconstitution inflammatory syndrome with high dose steroids, as well as empirical mirtazapine and mefloquine, were associated with a benign PML disease course and outcome.
authors.affiliation: Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, Sir Charles Gairdner Hospital, 4th Floor, A Block, QEII Medical Centre, Verdun Street, Nedlands, WA 6009, Australia.
authors.forename: Marzena J
authors.initials: MJ
authors.lastname: Fabis-Pedrini
authors.affiliation: Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, Sir Charles Gairdner Hospital, 4th Floor, A Block, QEII Medical Centre, Verdun Street, Nedlands, WA 6009, Australia; Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Xu
authors.affiliation: Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, Sir Charles Gairdner Hospital, 4th Floor, A Block, QEII Medical Centre, Verdun Street, Nedlands, WA 6009, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Burton
authors.affiliation: Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, Sir Charles Gairdner Hospital, 4th Floor, A Block, QEII Medical Centre, Verdun Street, Nedlands, WA 6009, Australia.
authors.forename: William M
authors.initials: WM
authors.lastname: Carroll
authors.affiliation: Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, Sir Charles Gairdner Hospital, 4th Floor, A Block, QEII Medical Centre, Verdun Street, Nedlands, WA 6009, Australia; Institute of Immunology and Infectious Diseases, Murdoch University, Murdoch, WA 6150, Australia. Electronic address: kermode@me.com.
authors.forename: Allan G
authors.initials: AG
authors.lastname: Kermode
mesh_terms: D000328:Adult; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects*; D007577:JC Virus / Q000276:immunology; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced*; D008279:Magnetic Resonance Imaging; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D000069442:Natalizumab / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D007155:Immunologic Factors; D000069442:Natalizumab
keywords: Immune reconstitution inflammatory syndrome; Multiple sclerosis; Natalizumab; Progressive multifocal leukoencephalopathy