Asymptomatic progressive multifocal leukoencephalopathy during natalizumab therapy with treatment. (March 2016)

• Record Type: Journal Article
• Authors: Fabis-Pedrini, Marzena J.; Xu, Wen; Burton, Jason; Carroll, William M.; Kermode, Allan G.
• Is Part Of: Journal of clinical neuroscience. Volume 25(2016:Mar.)
• Page Start: 145
• Page End: 147
• Publication Date: 2016-03
• Subjects: Immune reconstitution inflammatory syndrome -- Multiple sclerosis -- Natalizumab -- Progressive multifocal leukoencephalopathy; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2015.08.027
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: We report a case of asymptomatic progressive multifocal leukoencephalopathy (PML) detected on regular MRI screening. The initial MRI detection of PML was both atypical and subtle. Pre-emptive treatment was associated with a benign PML course and outcome. Changes on MRI during natalizumab treatment may suggest PML as a possible cause. 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.