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	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Berger, J. R. Editorial by Drazen, J. M. Letters Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

SUMMARY

We describe the clinical course of a patient with multiple sclerosis in whom progressive multifocal leukoencephalopathy (PML), an opportunistic viral infection of the central nervous system, developed during treatment with interferon beta-1a and a selective adhesion-molecule blocker, natalizumab. The first PML lesion apparent on magnetic resonance imaging was indistinguishable from a multiple sclerosis lesion. Despite treatment with corticosteroids, cidofovir, and intravenous immune globulin, PML progressed rapidly, rendering the patient quadriparetic, globally aphasic, and minimally responsive. Three months after natalizumab therapy was discontinued, changes consistent with an immune-reconstitution inflammatory syndrome 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.

Full Text of this Article

Related Letters:

Progressive Multifocal Leukoencephalopathy, Natalizumab, and Multiple Sclerosis
Berger T., Deisenhammer F., Álvarez-Cermeño J. C., Masjuan J., Villar L. M., Kleinschmidt-DeMasters B.K., Tyler K. L., Langer-Gould A., Atlas S. W., Pelletier D.
Extract | Full Text | PDF  
N Engl J Med 2005; 353:1744-1746, Oct 20, 2005. Correspondence

Natalizumab and Progressive Multifocal Leukoencephalopathy
Adelman B., Sandrock A., Panzara M. A.
Extract | Full Text | PDF  
N Engl J Med 2005; 353:432-433, Jul 28, 2005; published at www.nejm.org on Jun 9, 2005 (10.1056/NEJMc055235). Correspondence

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