Progressive Multifocal Leukoencephalopathy after Natalizumab Monotherapy

被引：173

作者：

Linda, Hans ^{[1
]}

von Heijne, Anders ^{[2
]}

Major, Eugene O. ^{[4
]}

Ryschkewitsch, Caroline ^{[4
]}

Berg, Johan ^{[1
]}

Olsson, Tomas ^{[3
]}

Martin, Claes ^{[1
]}

机构：

[1] Danderyd Hosp, Karolinska Inst, Neurol Unit, Div Internal Med, SE-18288 Stockholm, Sweden

[2] Danderyd Hosp, Karolinska Inst, Dept Radiol, SE-18288 Stockholm, Sweden

[3] Danderyd Hosp, Karolinska Inst, Neuroimmunol Unit, Dept Clin Neurosci, SE-18288 Stockholm, Sweden

[4] NINDS, Lab Mol Med & Neurosci, NIH, Bethesda, MD 20892 USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2009年 / 361卷 / 11期

基金：

瑞典研究理事会;

关键词：

JC VIRUS-DNA; RELAPSING MULTIPLE-SCLEROSIS; CEREBROSPINAL-FLUID; CONTROLLED TRIAL; CROHNS-DISEASE; THERAPY; PCR;

D O I：

10.1056/NEJMoa0810316

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：1081 / 1087

页数：7

共 22 条

[1] Progressive multifocal leukoencephalopathy [J].

Aksamit, Allen J. .

CURRENT TREATMENT OPTIONS IN NEUROLOGY, 2008, 10 (03) :178-185

[2] Influence of HAART on the clinical course of HIV-1-infected patients with progressive multifocal leukoencephalopathy:: Results of an observational multicenter study [J].

Falco, Vicenc ;

Olmo, Montserrat ;

Villar del Saz, Sara ;

Guelar, Ana ;

Santos, Jose R. ;

Gutierrez, Mar ;

Colomer, Daniel ;

Deig, Elisabet ;

Mateo, Gracia ;

Montero, Milagro ;

Pedrol, Enric ;

Podzamczer, Daniel ;

Domingo, Pere ;

Llibre, Josep M. .

JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, 2008, 49 (01) :26-31

[3]

Hamilton RS, 2000, J CLIN MICROBIOL, V38, P105

[4] Central nervous system infections -: a potential complication of systemic immunotherapy [J].

Hemmer, B ;

Frohman, E ;

Hartung, HP ;

Stüve, O .

CURRENT OPINION IN NEUROLOGY, 2006, 19 (03) :271-276

[5] Analysis of cerebrospinal fluid and cerebrospinal fluid cells from patients with multiple sclerosis for detection of JC virus DNA [J].

Iacobaeus, E. ;

Ryschkewitsch, C. ;

Gravell, M. ;

Khademi, M. ;

Wallstrom, E. ;

Olsson, T. ;

Brundin, L. ;

Major, E. O. .

MULTIPLE SCLEROSIS JOURNAL, 2009, 15 (01) :28-35

[6] Effect of plasma exchange in accelerating natalizumab clearance and restoring leukocyte function [J].

Khatri, B. O. ;

Man, S. ;

Giovannoni, G. ;

Koo, A. P. ;

Lee, J. -C. ;

Tucky, B. ;

Lynn, F. ;

Jurgensen, S. ;

Woodworth, J. ;

Goelz, S. ;

Duda, P. W. ;

Panzara, M. A. ;

Ransohoff, R. M. ;

Fox, R. J. .

NEUROLOGY, 2009, 72 (05) :402-409

[7] Brief report - Progressive multifocal leukoencephalopathy complicating treatment with natalizumab and interferon beta-1a for multiple sclerosis [J].

Kleinschmidt-DeMasters, BK ;

Tyler, KL .

NEW ENGLAND JOURNAL OF MEDICINE, 2005, 353 (04) :369-374

[8] New insights into progressive multifocal leukoencephalopathy [J].

Koralnik, IJ .

CURRENT OPINION IN NEUROLOGY, 2004, 17 (03) :365-370

[9] False negative PCR despite high levels of JC virus DNA in spinal fluid: Implications for diagnostic testing [J].

Landry, Marie L. ;

Eid, Tore ;

Bannykh, Serguei ;

Major, Eugene .

JOURNAL OF CLINICAL VIROLOGY, 2008, 43 (02) :247-249

[10] Brief report - Progressive multifocal leukoencephalopathy in a patient treated with natalizumab [J].

Langer-Gould, A ;

Atlas, SW ;

Green, AJ ;

Bollen, AW ;

Pelletier, D .

NEW ENGLAND JOURNAL OF MEDICINE, 2005, 353 (04) :375-381

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