title: Progressive Multifocal Leukoencephalopathy in a Multiple Sclerosis Patient Diagnosed after Switching from Natalizumab to Fingolimod.
abstract: Background. Natalizumab- (NTZ-) associated progressive multifocal leukoencephalopathy (PML) is a severe and often disabling infectious central nervous system disease that can become evident in multiple sclerosis (MS) patients after NTZ discontinuation. Recently, novel diagnostic biomarkers for the assessment of PML risk in NTZ treated MS patients such as the anti-JC virus antibody index have been reported, and the clinical relevance of milky-way lesions detectable by MRI has been discussed.Case Presentation and Conclusion. We report a MS patient in whom PML was highly suspected solely based on MRI findings after switching from NTZ to fingolimod despite repeatedly negative (ultrasensitive) polymerase chain reaction (PCR) testing for JC virus DNA in cerebrospinal fluid. The PML diagnosis was histopathologically confirmed by brain biopsy. The occurrence of an immune reconstitution inflammatory syndrome (IRIS) during fingolimod therapy, elevated measures of JCV antibody indices, and the relevance of milky-way-like lesions detectable by (7 T) MRI are discussed.
authors.affiliation: Department of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, Germany; NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Universitätsspital Basel, Basel, Switzerland.
authors.forename: Tim
authors.initials: T
authors.lastname: Sinnecker
authors.affiliation: Department of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, Germany.
authors.forename: Jalal
authors.initials: J
authors.lastname: Othman
authors.affiliation: Department of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Kühl
authors.affiliation: Department of Neuropathology, Universitätsmedizin Göttingen, Göttingen, Germany.
authors.forename: Imke
authors.initials: I
authors.lastname: Metz
authors.affiliation: Berlin Ultrahigh Field Facility, Max Delbrück Center for Molecular Medicine, Berlin, Germany; Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany.
authors.forename: Thoralf
authors.initials: T
authors.lastname: Niendorf
authors.affiliation: Department of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, Germany.
authors.forename: Annett
authors.initials: A
authors.lastname: Kunkel
authors.affiliation: NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany; Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany; Clinical and Experimental Multiple Sclerosis Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Friedemann
authors.identifier: 0000-0002-6378-0070
authors.initials: F
authors.lastname: Paul
authors.affiliation: NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany; Medical Imaging Analysis Center AG, Basel, Switzerland.
authors.forename: Jens
authors.initials: J
authors.lastname: Wuerfel
authors.affiliation: Department of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Faiss