We describe the clinical course of a patient with multiple sclerosisin whom progressive multifocal leukoencephalopathy (PML), anopportunistic viral infection of the central nervous system,developed during treatment with interferon beta-1a and a selectiveadhesion-molecule blocker, natalizumab. The first PML lesionapparent on magnetic resonance imaging was indistinguishablefrom a multiple sclerosis lesion. Despite treatment with corticosteroids,cidofovir, and intravenous immune globulin, PML progressed rapidly,rendering the patient quadriparetic, globally aphasic, and minimallyresponsive. Three months after natalizumab therapy was discontinued,changes consistent with an immune-reconstitution inflammatorysyndrome developed. The patient was treated with systemic cytarabine,and two months later, his condition had improved.
Source Information
From the Departments of Neurology and Health Research and Policy, Stanford University School of Medicine, Stanford, Calif. (A.L.-G.); the Department of Radiology, Hoover Institution at Stanford University, Stanford, Calif. (S.W.A.); and the Departments of Pathology (A.W.B.) and Neurology (A.J.G., D.P.), University of California, San Francisco, San Francisco. This article was published at www.nejm.org on June 9, 2005.
Address reprint requests to Dr. Annette Langer-Gould at HRP Redwood Bldg., Rm. T202, Stanford, CA 94305-5405, or at annette1{at}stanford.edu.
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