Management and outcome of CSF-JC virus PCR-negative PML in a natalizumab-treated patient with MS.

Abstract:

OBJECTIVE:To describe the diagnosis and management of a 49-year-old woman with multiple sclerosis (MS) developing a progressive hemiparesis and expanding MRI lesion suspicious of progressive multifocal leukoencephalopathy (PML) 19 months after starting natalizumab. RESULTS:Polyomavirus JC (JCV)-specific qPCR in CSF was repeatedly negative, but JCV-specific antibodies indicated intrathecal production. Brain biopsy tissue taken 17 weeks after natalizumab discontinuation and plasmapheresis was positive for JCV DNA with characteristic rearrangements of the noncoding control region, but histology and immunohistochemistry were not informative except for pathologic features compatible with immune reconstitution inflammatory syndrome. A total of 22 months later, the clinical status had returned close to baseline level paralleled by marked improvement of neuroradiologic abnormalities. CONCLUSIONS:This case illustrates diagnostic challenges in the context of incomplete suppression of immune surveillance and the potential of recovery of PML associated with efficient immune function restitution.

journal_name

Neurology

journal_title

Neurology

authors

Kuhle J,Gosert R,Bühler R,Derfuss T,Sutter R,Yaldizli O,Radue EW,Ryschkewitsch C,Major EO,Kappos L,Frank S,Hirsch HH

doi

10.1212/WNL.0b013e31823b9b27

subject

Has Abstract

pub_date

2011-12-06 00:00:00

pages

2010-6

issue

23

eissn

0028-3878

issn

1526-632X

pii

WNL.0b013e31823b9b27

journal_volume

77

pub_type

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