Progressive multifocal leukoencephalopathy in a patient treated with natalizumab.

@article{LangerGould2005ProgressiveML,
  title={Progressive multifocal leukoencephalopathy in a patient treated with natalizumab.},
  author={Annette M Langer-Gould and Scott W. Atlas and Ari J Green and Andrew W. Bollen and Daniel Pelletier},
  journal={The New England journal of medicine},
  year={2005},
  volume={353 4},
  pages={
          375-81
        }
}
We describe the clinical course of a patient with multiple sclerosis in whom progressive multifocal leukoencephalopathy (PML), an opportunistic viral infection of the central nervous system, developed during treatment with interferon beta-1a and a selective adhesion-molecule blocker, natalizumab. The first PML lesion apparent on magnetic resonance imaging was indistinguishable from a multiple sclerosis lesion. Despite treatment with corticosteroids, cidofovir, and intravenous immune globulin… 

Figures from this paper

Progressive multifocal leukoencephalopathy: new concepts.

  • M. Lima
  • Biology, Medicine
    Arquivos de neuro-psiquiatria
  • 2013
The new concepts on PML are discussed, emphasizing the recent modification in the epidemiology; the impact of new immunomodulatory treatments in the disease, PML-IRIS (Immune reconstitution inflammatory syndrome), new treatment strategies and other JCV related CNS diseases.

Progressive multifocal leukoencephalopathy and JC Virus-related disease in modern neurology practice.

Progressive Multifocal Leukoencephalopathy and Immune Reconstitution Inflammatory Syndrome after Discontinuation of Fingolimod

A clinical case of a patient with MS who, after the withdrawal of fingolimod, developed PML-IRIS despite sustained lymphopenia is presented, important for pharmacovigilance purposes, not only for NTZ but also for alternative drugs used in MS treatment.

Progressive multifocal leucoencephalopathy in an immunocompetent patient with favourable outcome. A case report

PML should be considered in immunocompetent patients with a typical clinical course and MRI findings compatible with PML, and treatment with cidofovir should be consider as early as possible in the disease course.

Drug‐induced progressive multifocal leukoencephalopathy in multiple sclerosis: A comprehensive review

In the era of disease‐modifying therapies for the treatment of MS, neurologists need to consider drug‐induced PML in MS.

Progressive multifocal leukoencephalopathy in myelodysplastic syndrome involving pure red cell aplasia.

A case of progressive multifocal leukoencephalopathy is described in a 76-year-old woman with myelodysplastic syndrome, who had been treated with azathioprine for a pure red cell aplasia-like condition and who died ten months after the diagnosis.

Indolent course of progressive multifocal leukoencephalopathy during natalizumab treatment in MS

Progressive multifocal leukoencephalopathy (PML) has developed in more than 40 patients with multiple sclerosis treated with natalizumab, in which, in almost all, PML presented as an aggressive disease with a short interval between first symptoms and diagnosis.

Progressive Multifocal Leukoencephalopathy

The current knowledge on the life cycle of JCV, pathogenesis of PML, important tools in the diagnosis, potential targets for management and therapeutic intervention ofPML are reviewed.

Progressive multifocal leukoencephalopathy: a review of the neuroimaging features and differential diagnosis

Patients under treatment with monoclonal antibodies in routine practice, or new ones in ongoing clinical trials, differentiating PML from new MS lesions on brain MRI is critical for both neurologists and neuroradiologists.

Antiviral Therapy for Progressive Multifocal Leukoencephalopathy

From all drugs tested CMX001, mirtazapine and risperdone appear to be most promising, these drugs cross the blood brain barrier (BBB), are well tolerated and show promising results in case reports.
...

References

SHOWING 1-10 OF 16 REFERENCES

Progressive multifocal leukoencephalopathy in patients with AIDS: appearance on MR images.

Despite reported findings on computed tomographic scans, PML in patients with AIDS has a variable appearance on MR images and has many characteristics that differ from those previously thought to be typical on imaging studies.

Failure of cytarabine in progressive multifocal leukoencephalopathy associated with human immunodeficiency virus infection. AIDS Clinical Trials Group 243 Team.

Cytarabine administered either intravenously or intrathecally does not improve the prognosis of HIV-infected patients with progressive multifocal leukoencephalopathy who are treated with the antiretroviral agents, nor does high-dose antireTroviral therapy alone appear to improve survival over that reported in untreated patients.

A controlled trial of natalizumab for relapsing multiple sclerosis.

In a placebo-controlled trial, treatment with natalizumab led to fewer inflammatory brain lesions and fewer relapses over a six-month period in patients with relapsing multiple sclerosis.

Progressive multifocal leukoencephalopathy.

Prevalence of antibodies in human sera against JC virus, an isolate from a case of progressive multifocal leukoencephalopathy.

The finding that JC virus agglutinates human type O erythrocytes permitted the rapid assaying of human sera for antibodies against this virus to give an indication of the incidence of infection by JC virus.

Alpha4 integrins as therapeutic targets in autoimmune disease.

In this issue of the Journal, two groups of investigators report on clinical trials of natalizumab, a recombinant monoclonal antibody against α4 integrins, for the treatment of multiple sclerosis1

The effect of anti-α4 integrin antibody on brain lesion activity in MS

Short-term treatment with monoclonal antibody against α4 integrin results in a significant reduction in the number of new active lesions on MRI, and further studies will be required to determine the longer term effect of this treatment on MRI and clinical outcomes.

The efficacy of nucleoside analogs against JC virus multiplication in a persistently infected human fetal brain cell line.

Of the three drugs tested, Ara-C (cytosine arabinoside), AZT (3'-azido-3'-deoxythymidine), and cidofovir (S)-1-[3-hydroxy-2-(phosphonylmethoxypropyl] cytosine), only Ara- C showed a significant effect in decreasing active JCV replication and multiplication.