PMID- 22517104
OWN - NLM
STAT- MEDLINE
DCOM- 20120627
LR  - 20220408
IS  - 1526-632X (Electronic)
IS  - 0028-3878 (Print)
IS  - 0028-3878 (Linking)
VI  - 78
IP  - 18
DP  - 2012 May 1
TI  - Simultaneous PML-IRIS after discontinuation of natalizumab in a patient with MS.
PG  - 1390-3
LID - 10.1212/WNL.0b013e318253d61e [doi]
AB  - OBJECTIVE: Progressive multifocal leukoencephalopathy (PML) is a severe 
      complication of natalizumab therapy in patients with multiple sclerosis (MS), 
      which is often accompanied by an immune reconstitution inflammatory syndrome 
      (IRIS) after removal of the drug. We describe a patient with MS who presented 
      with simultaneous PML-IRIS 2 months after stopping natalizumab for other reasons. 
      CASE REPORT AND RESULTS: The patient had widespread PML and severe IRIS. He 
      received corticosteroids and displayed a vigorous JC virus-specific cellular 
      immune response. Elevated myoinositol and lipid/creatine peaks measured in PML 
      lesions by proton magnetic resonance spectroscopy ((1)H-MRS) corresponded to 
      episodes of contrast enhancement on MRI scans and persisted after the enhancement 
      subsided. He demonstrated steady clinical improvement, but developed marked 
      residual atrophy in areas affected by PML and inflammation, as well as seizures. 
      CONCLUSIONS: New enhancing white matter lesions, occurring after discontinuation 
      of natalizumab, can be the manifestation of PML-IRIS rather than an MS 
      exacerbation. Elevated myoinositol and lipid/creatine peaks appear to be more 
      sensitive markers of inflammation in PML lesions than contrast enhancement. 
      (1)H-MRS may become useful as a biomarker for PML-IRIS by helping clinicians 
      determine the need for corticosteroid administration and anticipate continuing 
      clinical recovery.
FAU - Gheuens, S
AU  - Gheuens S
AD  - Division of NeuroVirology, Beth Israel Deaconess Medical Center, Harvard Medical 
      School, Boston, MA, USA.
FAU - Smith, D R
AU  - Smith DR
FAU - Wang, X
AU  - Wang X
FAU - Alsop, D C
AU  - Alsop DC
FAU - Lenkinski, R E
AU  - Lenkinski RE
FAU - Koralnik, I J
AU  - Koralnik IJ
LA  - eng
GR  - K24 NS060950/NS/NINDS NIH HHS/United States
GR  - R01 NS047029/NS/NINDS NIH HHS/United States
GR  - R56 NS041198/NS/NINDS NIH HHS/United States
GR  - T32 AI007387/AI/NIAID NIH HHS/United States
PT  - Case Reports
PT  - Journal Article
DEP - 20120418
PL  - United States
TA  - Neurology
JT  - Neurology
JID - 0401060
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 0 (Biomarkers)
RN  - 0 (Natalizumab)
SB  - IM
CIN - Neurology. 2012 Nov 20;79(21):2160; author reply 2160. PMID: 23170016
MH  - Alcoholic Intoxication/complications
MH  - Antibodies, Monoclonal, Humanized/*adverse effects/therapeutic use
MH  - Atrophy
MH  - Biomarkers/analysis
MH  - Brain/drug effects/pathology
MH  - Follow-Up Studies
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*chemically induced/diagnosis
MH  - Leukoencephalopathy, Progressive Multifocal/*chemically induced/diagnosis
MH  - Magnetic Resonance Imaging
MH  - Magnetic Resonance Spectroscopy
MH  - Male
MH  - Multiple Sclerosis, Relapsing-Remitting/*drug therapy
MH  - Natalizumab
MH  - Neurologic Examination
MH  - Spinal Cord/drug effects/pathology
MH  - Substance Withdrawal Syndrome/*diagnosis
MH  - Young Adult
PMC - PMC3345789
EDAT- 2012/04/21 06:00
MHDA- 2012/06/28 06:00
PMCR- 2013/05/01
CRDT- 2012/04/21 06:00
PHST- 2012/04/21 06:00 [entrez]
PHST- 2012/04/21 06:00 [pubmed]
PHST- 2012/06/28 06:00 [medline]
PHST- 2013/05/01 00:00 [pmc-release]
AID - WNL.0b013e318253d61e [pii]
AID - WNL203672 [pii]
AID - 10.1212/WNL.0b013e318253d61e [doi]
PST - ppublish
SO  - Neurology. 2012 May 1;78(18):1390-3. doi: 10.1212/WNL.0b013e318253d61e. Epub 2012 
      Apr 18.