Sequential MRI, Cerebrospinal Fluid and Peripheral Blood Immunologic Analysis in a Natalizumab-Treated Patient With Progressive Multifocal Leukoencephalopathy

Clara de Andres, Barbara Alonso, Juan Guzman de Villoria, Rosa Peraita-Adrados, Silvia Sanchez-Ramon


We report a natalizumab (NTZ)-treated relapsing-remitting multiple sclerosis (RRMS) patient evaluated for worsening of pyramidal and cerebellar dysfunction. MRI showed Gd+ lesions in juxtacortical frontal areas and middle cerebellar peduncles indicative of progressive multifocal leukoencephalopathy (PML). Cerebrospinal fluid (CSF) showed 47 JC virus (JCV) copies/mL, high CD8+ and plasmacytoid dendritic cells (pDCs) compared to peripheral blood (PB). MRI after NTZ discontinuation and plasma exchange revealed PML aggravation. CSF JCV increased to 475 as CD4+, CD19+ and pDCs. CSF 8 months later showed high CD4+, CD19+, pDCS, not JCV. MRI showed severe focal cortical atrophy and axonal degeneration of pontocerebellar fibers. Specific immune-cell response in the central nervous system (CNS) may be essential for control of PML.

J Med Cases. 2015;6(4):163-166


Immune cells; Inflammatory progressive multifocal leukoencephalopathy; Multiple sclerosis; MRI; Natalizumab

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