Natalizumab-associated Progressive Multifocal Leukoencephalopathy in Patients with Multiple Sclerosis: A Mini Review.

Muniba Fayyaz,Syeda S Jaffery

doi:10.7759/cureus.3093

Abstract

Progressive multifocal leukoencephalopathy is a fatal demyelinating disease caused by the John Cunningham virus. It causes white matter inflammation in multiple areas of the brain. Although rare, it has been known to occur in patients with immunodeficiency states and those taking chronic immunosuppressive medications for diseases such as multiple sclerosis and psoriasis. In this article, we will discuss about the drug-induced progressive multifocal encephalopathy and its diagnosis and management in patients taking natalizumab and other disease-modifying therapies among patients with multiple sclerosis.

Highlights

BackgroundProgressive multifocal leukoencephalopathy (PML) is a rare life-threatening disease, caused by the reactivation of John Cunningham (JC) virus
Progressive multifocal leukoencephalopathy is a fatal demyelinating disease caused by the John Cunningham virus
We will discuss about the drug-induced progressive multifocal encephalopathy and its diagnosis and management in patients taking natalizumab and other disease-modifying therapies among patients with multiple sclerosis

Summary

Introduction

Progressive multifocal leukoencephalopathy (PML) is a rare life-threatening disease, caused by the reactivation of John Cunningham (JC) virus. Maillart et al demonstrated the clinico-radiologic outcomes in patients with MS taking diseasemodifying therapies (DMTs) after suffering from natalizumab-associated PML They concluded that no clinical worsening and relapse of PML symptoms were reported with fingolimod and dimethyl fumarate. Lanzillo et al demonstrated the use of CRP in natalizumab-treated MS patients who underwent the JC virus stratify antibody test to measure the serum ultrasensitive C-reactive protein (usCRP) levels, and to perform blood and urine JC virus PCR They concluded that the level of usCRP was higher in urinary JCV DNA-positive patients and correlated with the number of DNA copies in urine. This management approach reduced the incidence and improved the survival of patients with PML (especially HIV patients), the outcome in most of the PML patients is still relatively poor [15,16,17,18]

Conclusions

Findings

Disclosures