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A case of natalizumab-associated progressive multifocal leukoencephalopathy with repeated negative CSF JCV testing

Monica E Mazda1, Jared R Brosch, Andrea L Wiens

  • 1Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA. monicamazda@gmail.com

The International Journal of Neuroscience
|December 21, 2012
PubMed

Insights

Progressive multifocal leukoencephalopathy (PML) can occur in natalizumab-treated patients. Diagnostic tests for PML, like JCV DNA PCR, may be insensitive, necessitating further investigation like brain biopsy.

Area of Science:

  • Neuroimmunology
  • Viral Pathogenesis

Background:

  • Natalizumab is an effective treatment for multiple sclerosis (MS).
  • Progressive multifocal leukoencephalopathy (PML) is a rare but serious risk associated with natalizumab therapy.
  • Demyelinating lesions in MS can mimic PML, complicating diagnosis.

Observation:

  • A case where cerebrospinal fluid (CSF) testing for John Cunningham virus (JCV) DNA via PCR was negative.
  • Brain biopsy ultimately confirmed PML via immunohistochemistry despite negative CSF PCR results.

Findings:

  • Current diagnostic methods for PML, including JCV DNA PCR in CSF, may have limitations in sensitivity.
  • Immunohistochemistry on brain biopsy is a definitive diagnostic tool for PML.

Implications:

  • The findings highlight the need for careful clinical monitoring of natalizumab-treated MS patients for PML.
  • Alternative diagnostic strategies may be required when CSF PCR is negative but clinical suspicion for PML is high.
  • This underscores the importance of considering definitive diagnostic procedures when faced with ambiguous cases.

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