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Progressive multifocal leukoencephalopathy in a multiple Sclerosis patient diagnosed after switching from natalizumab to fingolimod

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Item Type:Article
Title:Progressive multifocal leukoencephalopathy in a multiple Sclerosis patient diagnosed after switching from natalizumab to fingolimod
Creators Name:Sinnecker, T. and Othman, J. and Kühl, M. and Metz, I. and Niendorf, T. and Kunkel, A. and Paul, F. and Wuerfel, J. and Faiss, Juergen
Abstract:Background: Natalizumab- (NTZ-) associated progressive multifocal leukoencephalopathy (PML) is a severe and often disabling infectious central nervous system disease that can become evident in multiple sclerosis (MS) patients after NTZ discontinuation. Recently, novel diagnostic biomarkers for the assessment of PML risk in NTZ treated MS patients such as the anti-JC virus antibody index have been reported, and the clinical relevance of milky-way lesions detectable by MRI has been discussed. Case Presentation and Conclusion: We report a MS patient in whom PML was highly suspected solely based on MRI findings after switching from NTZ to fingolimod despite repeatedly negative (ultrasensitive) polymerase chain reaction (PCR) testing for JC virus DNA in cerebrospinal fluid. The PML diagnosis was histopathologically confirmed by brain biopsy. The occurrence of an immune reconstitution inflammatory syndrome (IRIS) during fingolimod therapy, elevated measures of JCV antibody indices, and the relevance of milky-way-like lesions detectable by (7 T) MRI are discussed.
Source:Case Reports in Neurological Medicine
ISSN:2090-6676
Publisher:Hindawi (U.K.)
Volume:2016
Page Range:5876798
Date:22 November 2016
Official Publication:https://doi.org/10.1155/2016/5876798
PubMed:View item in PubMed

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