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Previous Volume 361:1081-1087 September 10, 2009 Number 11 Next

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SUMMARY

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.

Source Information

From the Neurology Unit, Division of Internal Medicine (H.L., J.B., C.M.), the Department of Radiology (A.H.), and the Neuroimmunology Unit, Department of Clinical Neuroscience (T.O.), Danderyd Hospital, Karolinska Institutet, Stockholm; and the Laboratory of Molecular Medicine and Neuroscience, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (E.O.M., C.R.).

Address reprint requests to Dr. Lindå at the Division of Neurology, Department of Internal Medicine, Danderyd Hospital, SE-182 88 Stockholm, Sweden, or at hans.linda{at}ki.se.

Full Text of this Article

This article has been cited by other articles:

• (2009). Plasmapheresis for Managing Natalizumab-Associated PML: A Risky Proposition. JWatch Neurology 2009: 1-1 [Full Text]  
• Wenning, W., Haghikia, A., Laubenberger, J., Clifford, D. B., Behrens, P. F., Chan, A., Gold, R. (2009). Treatment of Progressive Multifocal Leukoencephalopathy Associated with Natalizumab. NEJM 361: 1075-1080 [Abstract] [Full Text]