Related Experiment Video

Updated: May 27, 2026

Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
10:35

Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction

Published on: December 3, 2017

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

J Kuhle1, R Gosert, R Bühler

  • 1Department of Biomedicine and Neurology, University Hospital Basel, Basel, Switzerland.

Neurology
|November 15, 2011
PubMed
Abstract

Insights

A multiple sclerosis (MS) patient developed progressive multifocal leukoencephalopathy (PML) despite negative initial tests. Recovery occurred with immune reconstitution, highlighting diagnostic challenges and treatment potential.

Area of Science:

  • Neuroimmunology
  • Viral Neurology

Background:

  • Natalizumab is an effective MS therapy, but carries a risk of progressive multifocal leukoencephalopathy (PML).
  • Early diagnosis of natalizumab-associated PML is crucial for management and prognosis.

Observation:

  • A 49-year-old woman with MS developed hemiparesis and an expanding MRI lesion 19 months after starting natalizumab.
  • Initial cerebrospinal fluid (CSF) testing for JC polyomavirus (JCV) was negative, but intrathecal antibody production was detected.

Findings:

  • Brain biopsy confirmed JCV DNA with characteristic noncoding control region rearrangements, despite negative CSF qPCR.
  • Histology suggested immune reconstitution inflammatory syndrome (IRIS).
  • Clinical and radiological recovery occurred 22 months after natalizumab discontinuation and plasmapheresis.

Implications:

  • This case highlights diagnostic difficulties with incomplete immune suppression and the potential for PML recovery with immune function restoration.
  • It underscores the importance of considering PML even with negative initial tests in natalizumab-treated patients.

More Related Videos

Use of In vivo Imaging to Monitor the Progression of Experimental Mouse Cytomegalovirus Infection in Neonates05:53

Use of In vivo Imaging to Monitor the Progression of Experimental Mouse Cytomegalovirus Infection in Neonates

Published on: July 6, 2013

Targeted Knockdown of Genes in the Choroid Plexus04:43

Targeted Knockdown of Genes in the Choroid Plexus

Published on: June 16, 2023

Related Concept Videos

Cytomegalovirus Disease01:27

Cytomegalovirus Disease

Cytomegalovirus (CMV) disease is caused by human cytomegalovirus, a double-stranded DNA virus of the Herpesviridae family. While primary CMV infection is often asymptomatic in immunocompetent individuals, the virus can cause severe disease in neonates and immunocompromised patients. CMV is the most common cause of congenital viral infection in the United States, and a major pathogen in solid organ and hematopoietic stem cell transplant recipients.CMV is transmitted via bodily fluids, sexual...
Multiple Sclerosis l: Introduction01:19

Multiple Sclerosis l: Introduction

Multiple sclerosis is a chronic autoimmune disease of the central nervous system (CNS) that affects the brain, spinal cord, and optic nerves. It is an inflammatory demyelinating disorder and a leading cause of neurological disability in young adults.EpidemiologyMS commonly begins between 20 and 40 years of age and is twice as common in women. Its exact cause remains unclear, but genetic susceptibility contributes, with higher risk in first-degree relatives and identical twins. A greater...
Acute Pyelonephritis II: Diagnostic Studies and Management01:28

Acute Pyelonephritis II: Diagnostic Studies and Management

Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
Arboviral Encephalitis01:25

Arboviral Encephalitis

Arboviral encephalitis refers to brain inflammation caused by arthropod-borne viruses, particularly those transmitted through mosquito vectors. Among these, West Nile virus (WNV), a member of the Flaviviridae family, is a significant public health concern. WNV is an enveloped, positive-sense, single-stranded RNA virus. Human infection typically begins when an infected mosquito introduces the virus into the dermis during feeding. The primary transmission cycle involves birds as amplifying hosts...
Encephalitis ll: Pathophysiology01:26

Encephalitis ll: Pathophysiology

Encephalitis is inflammation of the brain parenchyma caused by direct viral invasion or immune-mediated mechanisms triggered by infections or tumors. Both processes lead to neuronal injury, disrupted neurotransmission, and diverse neurological symptoms, often with overlapping clinical and pathological features.Autoimmune EncephalitisIn autoimmune encephalitis, antibodies target neuronal antigens on cell surfaces, synapses, or within neurons. A key example is anti-NMDAR encephalitis, which can...