Progressive Multifocal Leukoencephalopathy in a Multiple Sclerosis Patient Diagnosed after Switching from Natalizumab to Fingolimod
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 a...
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| Format: | Article |
| Language: | English |
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Wiley
2016-01-01
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| Series: | Case Reports in Neurological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2016/5876798 |
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| author | Tim Sinnecker Jalal Othman Marc Kühl Imke Metz Thoralf Niendorf Annett Kunkel Friedemann Paul Jens Wuerfel Juergen Faiss |
| author_facet | Tim Sinnecker Jalal Othman Marc Kühl Imke Metz Thoralf Niendorf Annett Kunkel Friedemann Paul Jens Wuerfel Juergen Faiss |
| author_sort | Tim Sinnecker |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-9d8b2fb9f7d1484da116169fe631b13f |
| institution | Kabale University |
| issn | 2090-6668 2090-6676 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Neurological Medicine |
| spelling | doaj-art-9d8b2fb9f7d1484da116169fe631b13f2025-02-03T01:03:21ZengWileyCase Reports in Neurological Medicine2090-66682090-66762016-01-01201610.1155/2016/58767985876798Progressive Multifocal Leukoencephalopathy in a Multiple Sclerosis Patient Diagnosed after Switching from Natalizumab to FingolimodTim Sinnecker0Jalal Othman1Marc Kühl2Imke Metz3Thoralf Niendorf4Annett Kunkel5Friedemann Paul6Jens Wuerfel7Juergen Faiss8Department of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, GermanyDepartment of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, GermanyDepartment of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, GermanyDepartment of Neuropathology, Universitätsmedizin Göttingen, Göttingen, GermanyBerlin Ultrahigh Field Facility, Max Delbrück Center for Molecular Medicine, Berlin, GermanyDepartment of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, GermanyNeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, GermanyNeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, GermanyDepartment of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, GermanyBackground. 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.http://dx.doi.org/10.1155/2016/5876798 |
| spellingShingle | Tim Sinnecker Jalal Othman Marc Kühl Imke Metz Thoralf Niendorf Annett Kunkel Friedemann Paul Jens Wuerfel Juergen Faiss Progressive Multifocal Leukoencephalopathy in a Multiple Sclerosis Patient Diagnosed after Switching from Natalizumab to Fingolimod Case Reports in Neurological Medicine |
| title | Progressive Multifocal Leukoencephalopathy in a Multiple Sclerosis Patient Diagnosed after Switching from Natalizumab to Fingolimod |
| title_full | Progressive Multifocal Leukoencephalopathy in a Multiple Sclerosis Patient Diagnosed after Switching from Natalizumab to Fingolimod |
| title_fullStr | Progressive Multifocal Leukoencephalopathy in a Multiple Sclerosis Patient Diagnosed after Switching from Natalizumab to Fingolimod |
| title_full_unstemmed | Progressive Multifocal Leukoencephalopathy in a Multiple Sclerosis Patient Diagnosed after Switching from Natalizumab to Fingolimod |
| title_short | Progressive Multifocal Leukoencephalopathy in a Multiple Sclerosis Patient Diagnosed after Switching from Natalizumab to Fingolimod |
| title_sort | progressive multifocal leukoencephalopathy in a multiple sclerosis patient diagnosed after switching from natalizumab to fingolimod |
| url | http://dx.doi.org/10.1155/2016/5876798 |
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