PMID- 24680560
OWN - NLM
STAT- MEDLINE
DCOM- 20141222
LR  - 20151119
IS  - 1878-5883 (Electronic)
IS  - 0022-510X (Linking)
VI  - 340
IP  - 1-2
DP  - 2014 May 15
TI  - Cryptococcal meningitis in a multiple sclerosis patient taking natalizumab.
PG  - 109-11
LID - S0022-510X(14)00150-6 [pii]
LID - 10.1016/j.jns.2014.03.007 [doi]
AB  - IMPORTANCE: Natalizumab was approved in 2004 by the US Food and Drug 
      Administration (US-FDA) for treatment of multiple sclerosis (MS), however it was 
      temporarily withdrawn after its use was associated with progressive multifocal 
      leukoencephalopathy (PML). Other reported adverse events have included melanoma, 
      primary central nervous system (CNS) lymphoma, and gastrointestinal 
      cryptosporidiosis. An MS exacerbation may occur after discontinuation and immune 
      reconstitution inflammatory syndrome (IRIS), particularly in the setting of PML, 
      is also possible. We present the first case of cryptococcal meningitis in a 
      patient taking natalizumab. Managements of both cryptococcal meningitis and MS 
      after discontinuation of natalizumab are the focus of this report. OBSERVATIONS: 
      This is a case report describing a 49-year old Caucasian man with 
      relapsing-remitting MS (RR-MS) on natalizumab. On the twenty-fourth month of 
      natalizumab treatment, he developed cryptococcal meningitis, prompting its 
      discontinuation. Two months later, off natalizumab, while on antifungal 
      treatment, he developed an MS exacerbation. Cerebrospinal fluid (CSF) JC virus 
      polymerase chain reaction (PCR) and human immunodeficiency virus (HIV) serology 
      were repeatedly negative. CONCLUSIONS AND RELEVANCE: Although specific 
      recommendations for treating natalizumab-associated cryptococcal meningitis do 
      not exist, our patient discontinued natalizumab and started conventional 
      anti-fungal treatment. Two months later, he was treated with steroids due to 
      worsening neurologic status from a presumed MS attack. Subsequently, he improved 
      with successful treatment of the cryptococcal meningitis, with no new clinical or 
      radiographic exacerbations.
CI  - Copyright (c) 2014 Elsevier B.V. All rights reserved.
FAU - Valenzuela, Reuben Mari
AU  - Valenzuela RM
AD  - Department of Neurology, University of Illinois College of Medicine, Illinois 
      Neurologic Institute, Department of Medicine, Peoria, United States.
FAU - Pula, John H
AU  - Pula JH
AD  - Department of Neurology, University of Illinois College of Medicine, Illinois 
      Neurologic Institute, Department of Medicine, Peoria, United States.
FAU - Garwacki, Dennis
AU  - Garwacki D
AD  - Department of Neurology, University of Illinois College of Medicine, Illinois 
      Neurologic Institute, Department of Medicine, Peoria, United States.
FAU - Cotter, John
AU  - Cotter J
AD  - Division of Infectious Diseases, University of Illinois College of Medicine, 
      Peoria, United States.
FAU - Kattah, Jorge C
AU  - Kattah JC
AD  - Department of Neurology, University of Illinois College of Medicine, Illinois 
      Neurologic Institute, Department of Medicine, Peoria, United States. Electronic 
      address: kattahj@uic.edu.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20140311
PL  - Netherlands
TA  - J Neurol Sci
JT  - Journal of the neurological sciences
JID - 0375403
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 0 (Natalizumab)
SB  - IM
MH  - Antibodies, Monoclonal, Humanized/*therapeutic use
MH  - Corpus Callosum/drug effects/pathology
MH  - Follow-Up Studies
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Meningitis, Cryptococcal/complications/*drug therapy
MH  - Middle Aged
MH  - Multiple Sclerosis/complications/*drug therapy
MH  - Natalizumab
OTO - NOTNLM
OT  - Cryptoccocal meningitis
OT  - Immune reconstitution inflammatory syndrome (IRIS)
OT  - Multiple sclerosis (MS)
OT  - Natalizumab
OT  - Progressive multifocal leukoencephalopathy (PML)
OT  - Relapsing-remitting MS
EDAT- 2014/04/01 06:00
MHDA- 2014/12/23 06:00
CRDT- 2014/04/01 06:00
PHST- 2013/09/11 00:00 [received]
PHST- 2014/02/11 00:00 [revised]
PHST- 2014/03/04 00:00 [accepted]
PHST- 2014/04/01 06:00 [entrez]
PHST- 2014/04/01 06:00 [pubmed]
PHST- 2014/12/23 06:00 [medline]
AID - S0022-510X(14)00150-6 [pii]
AID - 10.1016/j.jns.2014.03.007 [doi]
PST - ppublish
SO  - J Neurol Sci. 2014 May 15;340(1-2):109-11. doi: 10.1016/j.jns.2014.03.007. Epub 
      2014 Mar 11.