Abstract：
IMPORTANCE:Natalizumab was approved in 2004 by the US Food and Drug Administration (US-FDA) for treatment of multiple sclerosis (MS), however it was temporarily withdrawn after its use was associated with progressive multifocal leukoencephalopathy (PML). Other reported adverse events have included melanoma, primary central nervous system (CNS) lymphoma, and gastrointestinal cryptosporidiosis. An MS exacerbation may occur after discontinuation and immune reconstitution inflammatory syndrome (IRIS), particularly in the setting of PML, is also possible. We present the first case of cryptococcal meningitis in a patient taking natalizumab. Managements of both cryptococcal meningitis and MS after discontinuation of natalizumab are the focus of this report. OBSERVATIONS:This is a case report describing a 49-year old Caucasian man with relapsing-remitting MS (RR-MS) on natalizumab. On the twenty-fourth month of natalizumab treatment, he developed cryptococcal meningitis, prompting its discontinuation. Two months later, off natalizumab, while on antifungal treatment, he developed an MS exacerbation. Cerebrospinal fluid (CSF) JC virus polymerase chain reaction (PCR) and human immunodeficiency virus (HIV) serology were repeatedly negative. CONCLUSIONS AND RELEVANCE:Although specific recommendations for treating natalizumab-associated cryptococcal meningitis do not exist, our patient discontinued natalizumab and started conventional anti-fungal treatment. Two months later, he was treated with steroids due to worsening neurologic status from a presumed MS attack. Subsequently, he improved with successful treatment of the cryptococcal meningitis, with no new clinical or radiographic exacerbations.
journal_name
J Neurol Scijournal_title
Journal of the neurological sciencesauthors
Valenzuela RM,Pula JH,Garwacki D,Cotter J,Kattah JCdoi
10.1016/j.jns.2014.03.007subject
Has Abstractpub_date
2014-05-15 00:00:00pages
109-11issue
1-2eissn
0022-510Xissn
1878-5883pii
S0022-510X(14)00150-6journal_volume
340pub_type
杂志文章abstract：:The diagnostic value of analogue frequency analysis of EMG from patients with neuromuscular disorders has not been convincing. Using fast Fourier transformation it is today possible to obtain the EMG power spectrum on-line and with a better resolution. We examined the power spectrum of the EMG pattern of the brachial ...
journal_title：Journal of the neurological sciences
pub_type： 杂志文章
doi：10.1016/0022-510x(89)90237-2
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journal_title：Journal of the neurological sciences
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journal_title：Journal of the neurological sciences
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doi：10.1016/s0022-510x(00)00355-5
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journal_title：Journal of the neurological sciences
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journal_title：Journal of the neurological sciences
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jns.2010.03.002
更新日期：2010-06-15 00:00:00
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journal_title：Journal of the neurological sciences
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journal_title：Journal of the neurological sciences
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jns.2007.01.074
更新日期：2007-07-15 00:00:00
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journal_title：Journal of the neurological sciences
pub_type： 杂志文章,评审
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doi：10.1016/0022-510x(81)90043-5
更新日期：1981-04-01 00:00:00
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journal_title：Journal of the neurological sciences
pub_type： 杂志文章
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journal_title：Journal of the neurological sciences
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journal_title：Journal of the neurological sciences
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更新日期：1998-07-15 00:00:00
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journal_title：Journal of the neurological sciences
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journal_title：Journal of the neurological sciences
pub_type： 杂志文章,评审
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更新日期：1992-08-01 00:00:00
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journal_title：Journal of the neurological sciences
pub_type： 杂志文章
doi：10.1016/j.jns.2014.02.036
更新日期：2014-05-15 00:00:00
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journal_title：Journal of the neurological sciences
pub_type： 杂志文章
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