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Progressive multifocal leukoencephalopathy after natalizumab monotherapy.

Author(s): Linda H, von Heijne A, Major EO, Ryschkewitsch C, Berg J, Olsson T, Martin C

Affiliation(s): Neurology Unit, Division of Internal Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. hans.linda@ki.se

Publication date & source: 2009-09-10, N Engl J Med., 361(11):1081-7.

Publication type: Case Reports; Research Support, Non-U.S. Gov't

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. 2009 Massachusetts Medical Society

Page last updated: 2009-10-20

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