Progressive Multifocal Leukoencephalopathy in a Multiple Sclerosis Patient Diagnosed after Switching from Natalizumab to FingolimodReportar como inadecuado




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Case Reports in Neurological Medicine - Volume 2016 2016, Article ID 5876798, 8 pages -

Case Report

Department of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, Germany

NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany

Department of Neurology, Universitätsspital Basel, Basel, Switzerland

Department of Neuropathology, Universitätsmedizin Göttingen, Göttingen, Germany

Berlin Ultrahigh Field Facility, Max Delbrück Center for Molecular Medicine, Berlin, Germany

Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany

Clinical and Experimental Multiple Sclerosis Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany

Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany

Medical Imaging Analysis Center AG, Basel, Switzerland

Received 1 June 2016; Revised 21 August 2016; Accepted 12 October 2016

Academic Editor: Dominic B. Fee

Copyright © 2016 Tim Sinnecker et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.





Autor: Tim Sinnecker, Jalal Othman, Marc Kühl, Imke Metz, Thoralf Niendorf, Annett Kunkel, Friedemann Paul, Jens Wuerfel, and Ju

Fuente: https://www.hindawi.com/



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