Asymptomatic progressive multifocal leukoencephalopathy during natalizumab therapy with treatment

Marzena J Fabis-Pedrini; Wen Xu; Jason Burton; William M Carroll; Allan G Kermode

doi:10.1016/j.jocn.2015.08.027

Asymptomatic progressive multifocal leukoencephalopathy during natalizumab therapy with treatment

J Clin Neurosci. 2016 Mar:25:145-7. doi: 10.1016/j.jocn.2015.08.027. Epub 2015 Nov 2.

Authors

Marzena J Fabis-Pedrini¹, Wen Xu², Jason Burton¹, William M Carroll¹, Allan G Kermode³

Affiliations

¹ 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.
² 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.
³ 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.

PMID: 26541323
DOI: 10.1016/j.jocn.2015.08.027

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.

Keywords: Immune reconstitution inflammatory syndrome; Multiple sclerosis; Natalizumab; Progressive multifocal leukoencephalopathy.

Publication types

Case Reports
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Humans
Immunologic Factors / adverse effects*
JC Virus / immunology
Leukoencephalopathy, Progressive Multifocal / chemically induced*
Magnetic Resonance Imaging
Male
Multiple Sclerosis, Relapsing-Remitting / drug therapy*
Natalizumab / adverse effects*
Treatment Outcome

Substances

Immunologic Factors
Natalizumab