Progressive Multifocal Leukoencephalopathy after Natalizumab Monotherapy
Open Access
- 10 September 2009
- journal article
- research article
- Published by Massachusetts Medical Society in New England Journal of Medicine
- Vol. 361 (11), 1081-1087
- https://doi.org/10.1056/nejmoa0810316
Abstract
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.This publication has 22 references indexed in Scilit:
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