Contributions
Abstract: EP1759
Type: ePoster
Abstract Category: Therapy - disease modifying - 29 Risk management for disease modifying treatments
We report the development of asymptomatic progressive multifocal leukoencephalopathy (PML) in a 24-year-old woman with multiple sclerosis treated with natalizumab. The patient was diagnosed with PML based on characteristic MRI lesions after 27 infusions of natalizumab. She had no neurologic deficits at the time of diagnosis and John Cunningham virus (JCV) was detected at 15 copies/ml (NIH/NINDS, Bethesda, MD. USA). She was initially treated with mefloquine and mirtazapine and remained asymptomatic for three months. The patient later developed worsening MRI lesions related to immune reconstitution inflammatory syndrome (IRIS). At that time, she received intravenous immunoglobulin (IVIG) and high dose intravenous methylprednisone with radiographic improvement of the lesions. Our report illustrates that early detection of asymptomatic PML and its subsequent treatment resulted in a benign clinical course. In consideration of the additional small number of asymptomatic PML cases that have been reported, we conclude that routine MRI surveillance is important for MS patients that are at high risk for developing natalizumab-associated PML.
Disclosure:
Yinan Zhang: nothing to disclose
Crystal Wright: nothing to disclose
Angela Flores: nothing to disclose
Abstract: EP1759
Type: ePoster
Abstract Category: Therapy - disease modifying - 29 Risk management for disease modifying treatments
We report the development of asymptomatic progressive multifocal leukoencephalopathy (PML) in a 24-year-old woman with multiple sclerosis treated with natalizumab. The patient was diagnosed with PML based on characteristic MRI lesions after 27 infusions of natalizumab. She had no neurologic deficits at the time of diagnosis and John Cunningham virus (JCV) was detected at 15 copies/ml (NIH/NINDS, Bethesda, MD. USA). She was initially treated with mefloquine and mirtazapine and remained asymptomatic for three months. The patient later developed worsening MRI lesions related to immune reconstitution inflammatory syndrome (IRIS). At that time, she received intravenous immunoglobulin (IVIG) and high dose intravenous methylprednisone with radiographic improvement of the lesions. Our report illustrates that early detection of asymptomatic PML and its subsequent treatment resulted in a benign clinical course. In consideration of the additional small number of asymptomatic PML cases that have been reported, we conclude that routine MRI surveillance is important for MS patients that are at high risk for developing natalizumab-associated PML.
Disclosure:
Yinan Zhang: nothing to disclose
Crystal Wright: nothing to disclose
Angela Flores: nothing to disclose