Early detection and favourable outcome of natalizumab-related progressive multifocal leukoencephalopathy (PML) in two multiple sclerosis patients

Excerpt

A 42-year-old woman with RRMS and EDSS level of 7, previously treated with interferon (IFN)-β-1a and mitoxantrone, was started with natalizumab. JCV antibodies status test was not available at that time. After 31 infusions a routine MRI showed right parieto-occipital T2WI-hyperintense lesion with subcortical gadolinium (Gd) enhancement (Fig. 1), thus natalizumab treatment was immediately stopped. Right neglect, apraxia and alexia were present and EDSS increased to 8.5. CSF JCV-PCR performed at National Institute of Health Laboratory of Molecular Medicine and Neuroscience-Maryland, USA, (NINDS) was positive (24 DNA copies). She received only two of the seven scheduled PLEX cycles because of thrombosis on the site of venous catheterization. Oral prednisone (32.5 mg/day) was started and continued for the next 18 months. Cognitive functions gradually improved during 23-month follow-up as well as neurological examination (EDSS decreased to 7.5). Serial brain MRI scans showed stabilization of lesion size with progressive gadolinium enhancement disappearance (Fig. 2).

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