Natalizumab-Related Progressive Multifocal Leukoencephalopathy-Immune Reconstitution Inflammatory Syndrome: A Case Report Highlighting Clinical and MRI Features
- Author:
Bela Purohit
;
Eranga Ganewatte
;
Spyros S. Kollias
- Publication Type:Case Reports
- Keywords:
magnetic resonance imaging;
natalizumab;
multiple sclerosis;
progressive multifocal leukoencephalopathy;
immune reconstitution inflammatory syndrome
- From:Malaysian Journal of Medical Sciences
2016;23(5):91-95
- CountryMalaysia
- Language:English
-
Abstract:
Multiple sclerosis (MS) patients treated with natalizumab often face the uncommon
but severe complication of developing progressive multifocal leukoencephalopathy (PML).
PML may be further complicated by immune reconstitution inflammatory syndrome (IRIS)
after the removal of the drug. Since both PML and IRIS are associated with high morbidity and
mortality rates, early clinical and radiological diagnosis of these complications is of paramount
importance. Here, we report a case of an adult male patient who was diagnosed with PML after
receiving natalizumab therapy for 6 years for the treatment of MS. Upon cessation of natalizumab,
he presented with a paradoxical worsening of clinical and radiological findings consistent with
an inflammatory brain injury due to IRIS. He was treated with high dose corticosteroid therapy
followed by a gradual improvement in clinical and imaging findings. This article illustrates the
magnetic resonance imaging (MRI) features of natalizumab‑associated PML-IRIS, along with a
brief overview of its clinical features, complications and management strategies.
