Progressive multifocal leukoencephalopathy after natalizumab monotherapy.

Abstract

We describe progressive multifocal leukoencephalopathy (PML) caused by infection with human polyomavirus JC virus in a patient with multiple sclerosis who was treated with natalizumab. The first PML symptoms appeared after 14 monthly infusions of the drug. Magnetic resonance imaging (MRI) showed a presumed multiple sclerosis lesion, and JC virus DNA was not detected on polymerase-chain-reaction (PCR) assay of cerebrospinal fluid. The patient's symptoms worsened, and the diagnosis of PML was established with a more sensitive quantitative PCR assay after 16 infusions of natalizumab. Plasma exchange was used to accelerate clearance of natalizumab. Approximately 3 weeks after plasma exchange, an immune-reconstitution inflammatory syndrome appeared. JC virus DNA was no longer detectable on quantitative PCR assay, and the patient's symptoms improved.

• Authors: Hans Lindå, Anders von Heijne, Eugene O Major, Caroline Ryschkewitsch, Johan Berg, Tomas Olsson, Claes Martin
• Journal: The New England journal of medicine (N Engl J Med) Vol. 361 Issue 11 Pg. 1081-7 (Sep 10 2009) ISSN: 1533-4406 [Electronic] United States
• PMID: 19741229 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: 2009 Massachusetts Medical Society

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• DNA, Viral
• Natalizumab
• Integrin alpha4

Topics

• Adult
• Antibodies, Monoclonal (adverse effects, therapeutic use)
• Antibodies, Monoclonal, Humanized
• Brain (pathology)
• DNA, Viral (blood)
• Humans
• Immune Reconstitution Inflammatory Syndrome (etiology)
• Integrin alpha4 (immunology)
• JC Virus (genetics, immunology)
• Leukoencephalopathy, Progressive Multifocal (chemically induced, immunology)
• Magnetic Resonance Imaging
• Male
• Multiple Sclerosis (complications, drug therapy, pathology)
• Natalizumab
• Polymerase Chain Reaction