Progressive Multifocal Leukoencephalopathy after Natalizumab Monotherapy
Progressive Multifocal Leukoencephalopathy after Natalizumab Monotherapy
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DOI：
10.1056/nejmoa0810316
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发表时间：
2009-09-10
影响因子：
158.5
通讯作者：
Martin, Claes
中科院分区：
文献类型：
--
作者：
Linda, Hans;von Heijne, Anders;Martin, Claes
我们描述了一名接受那他珠单抗治疗的多发性硬化患者因感染人多瘤病毒JC病毒而引起的进行性多灶性白质脑病（PML）。首次PML症状出现在14个月的药物输注后。磁共振成像（MRI）显示一个假定的多发性硬化症病变，和JC病毒DNA聚合酶链反应（PCR）检测脑脊液中未检测到。患者的症状恶化，在输注16次那他珠单抗后，采用更灵敏的定量PCR测定法确定了PML的诊断。使用血浆置换加速那他珠单抗的清除。血浆置换后约3周，出现免疫重建炎症综合征。JC病毒DNA在定量PCR检测中不再可检测到，患者的症状得到改善。
We describe progressive multifocal leukoencephalopathy (PML) caused by infection with human polyomavirus JC virus in a patient with multiple sclerosis who was treated with natalizumab. The first PML symptoms appeared after 14 monthly infusions of the drug. Magnetic resonance imaging (MRI) showed a presumed multiple sclerosis lesion, and JC virus DNA was not detected on polymerase-chain-reaction (PCR) assay of cerebrospinal fluid. The patient's symptoms worsened, and the diagnosis of PML was established with a more sensitive quantitative PCR assay after 16 infusions of natalizumab. Plasma exchange was used to accelerate clearance of natalizumab. Approximately 3 weeks after plasma exchange, an immune-reconstitution inflammatory syndrome appeared. JC virus DNA was no longer detectable on quantitative PCR assay, and the patient's symptoms improved.