Ces radiol. 2015, 69(1):55-60 | DOI: 10.55095/CesRadiol2015/008

Progressive multifocal leukoencephalopathy - a possible complication of multiple sclerosis treatment with natalizumab: review from literature and case reportCase report

Monika Daňová¹, Eleonóra Klímová²

¹ Pro Magnet, s.r.o., magnetická rezonancia Prešov

² Klinika neurológie FNsP J. A. Reimana a Fakulty zdravotníckych odborov Prešovskej univerzity, Prešov

Progressive multifocal leukoencephalopathy (PML) is a serious opportunistic infection of the CNS, which typically develops in severe immunocompromised individuals (HIV infection, haematological malignancy, organ transplant), but recently also in patients with various types of autoimmune diseases, treated by biological treatment.
Natalizumab is a humanized monoclonal antibody against the cell adhesion molecule - α4β1 integrin, is used in the treatment of high active relapsing/remitting multiple sclerosis for several years.
The success of therapy with natalizumab complicates risk of PML, depends on treatment duration (more than 24 months), anti-JCV antibody serology status, and prior administration of immunosupressive drugs.
MRI findings of PML in multiple sclerosis patients treated with natalizumab are heterogenous an highly variable, in the early stages sometimes difficult to detect and completely different from PML of HIV patients. After natalizumab discontinuation, there were observed clinical and/or MRI evidence of reactivation of multiple sclerosis, in some cases IRIS-syndrome - which one we are unable to distinguish clinically from PML and it may complicates the treatment of PML after plasma exchange. These facts must be taken into account when interpreting MRI findings.

Keywords: magnetic resonance imaging, multiple sclerosis, progressive multifocal leukoencephalopathy, IRIS - immune reconstitution inflammatory syndrom

Accepted: January 30, 2015; Published: March 1, 2015  Show citation