Progressive multifocal leukoencephalopathy in patient with multiple sclerosis treated by natalizumab
Abstract
Natalizumab (monoclonal antibody) is currently indicated as a second line treatment for relapse-remitting multiple sclerosis (RR-MS). Serious and potential fatal side effect of this treatment is progressive multifocal leukoencefalopathy (PML), which belongs to rare brain infections caused by JC virus (JCV).
There is a progressive inflammation of the brain white matter in multiple localizations. A high risk of developing PML includes serum JCV positivity, previous immunosuppressive treatment and duration of natalizumab treatment of more than two years.
Magnetic resonance is one of the most important diagnostic methods because it can identify brain damage in the early stage of the disease.We present 47-years-old female with RR-MS which has been successfully treated by natalizumab for three years with very good clinical outcome. In last year of treatment, patient experienced a seizure and in later stages progressive deterioration of cognitive function and severe quadriplegia.
Positive JCV was found in cerebrospinal fluid. MR presented diffuse hyperintensive lesions located in frontal lobes.
Despite immediate discontinuation of natalizumab treatment and subsequent daily plasma-exchange PML disease progressed and patient died within two months of the final diagnosis. PML is a serious complication of natalizumab treatment in multiple sclerosis.
It is important to recognize early signs and symptoms of this disease. Therefore, it is necessary clinically and morphologically monitor the patients in high risk of PML with repeated MR (especially flair sequence) to prevent fatal complication