Management and outcome of CSF-JC virus PCR-negative PML in a natalizumabtreated patient with MS

被引：63

作者：

Kuhle, J. ^{[1
,2
]}

Gosert, R. ^{[8
]}

Buehler, R. ^{[9
]}

Derfuss, T. ^{[1
,2
]}

Sutter, R. ^{[2
,3
]}

Yaldizli, O. ^{[2
]}

Radue, E. -W. ^{[4
]}

Ryschkewitsch, C. ^{[10
]}

Major, E. O. ^{[10
]}

Kappos, L. ^{[1
,2
]}

Frank, S. ^{[5
]}

Hirsch, H. H. ^{[6
,7
,8
]}

机构：

[1] Univ Basel Hosp, Dept Biomed, CH-4031 Basel, Switzerland

[2] Univ Basel Hosp, Dept Neurol, CH-4031 Basel, Switzerland

[3] Univ Basel Hosp, Intens Care Unit, CH-4031 Basel, Switzerland

[4] Univ Basel Hosp, Med Image Anal Ctr, CH-4031 Basel, Switzerland

[5] Univ Basel Hosp, Inst Pathol, Div Neuropathol, CH-4031 Basel, Switzerland

[6] Univ Basel Hosp, Div Infect Dis, CH-4031 Basel, Switzerland

[7] Univ Basel Hosp, Hosp Epidemiol, CH-4031 Basel, Switzerland

[8] Univ Basel, Inst Med Microbiol, Dept Biomed, Basel, Switzerland

[9] Burgerspital, Dept Neurol, Solothurn, Switzerland

[10] NINDS, Lab Mol Med & Neurosci, NIH, Bethesda, MD USA

来源：

NEUROLOGY | 2011年 / 77卷 / 23期

基金：

新加坡国家研究基金会;

关键词：

PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY; RELAPSING MULTIPLE-SCLEROSIS; HUMORAL IMMUNE-RESPONSE; CEREBROSPINAL-FLUID; ANTIRETROVIRAL THERAPY; RECONSTITUTION; AMPLIFICATION; REPLICATION; SEQUENCES; DISEASE;

D O I：

10.1212/WNL.0b013e31823b9b27

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Objective: To describe the diagnosis and management of a 49-year-old woman with multiple sclerosis (MS) developing a progressive hemiparesis and expanding MRI lesion suspicious of progressive multifocal leukoencephalopathy (PML) 19 months after starting natalizumab. Results: Polyomavirus JC (JCV)-specific qPCR in CSF was repeatedly negative, but JCV-specific antibodies indicated intrathecal production. Brain biopsy tissue taken 17 weeks after natalizumab discontinuation and plasmapheresis was positive for JCV DNA with characteristic rearrangements of the noncoding control region, but histology and immunohistochemistry were not informative except for pathologic features compatible with immune reconstitution inflammatory syndrome. A total of 22 months later, the clinical status had returned close to baseline level paralleled by marked improvement of neuroradiologic abnormalities. Conclusions: This case illustrates diagnostic challenges in the context of incomplete suppression of immune surveillance and the potential of recovery of PML associated with efficient immune function restitution. Neurology (R) 2011; 77: 2010-2016

引用

页码：2010 / 2016

页数：7

共 29 条

[1] JC virus (JCV) genotypes in brain tissue from patients with progressive multifocal leukoencephalopathy (PML) and in urine from controls without PML: Increased frequency of JCV type 2 in PML [J].