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
Neurologyjournal_title
Neurologyauthors
Kuhle J,Gosert R,Bühler R,Derfuss T,Sutter R,Yaldizli O,Radue EW,Ryschkewitsch C,Major EO,Kappos L,Frank S,Hirsch HHdoi
10.1212/WNL.0b013e31823b9b27subject
Has Abstractpub_date
2011-12-06 00:00:00pages
2010-6issue
23eissn
0028-3878issn
1526-632Xpii
WNL.0b013e31823b9b27journal_volume
77pub_type
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