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Atypical MRI features at early onset natalizumab-associated progressive multifocal leukoencephalopathy: a case report

Mirko Piola1, Franco Di Palma1, Nerina Mascoli1

  • 1Neurology Unit, Department of Medicine, S. Anna Hospital, Como, Italy.

Journal of the Neurological Sciences
|March 20, 2014
PubMed

Insights

Progressive multifocal leukoencephalopathy (PML) can present with unusual MRI patterns in Multiple Sclerosis (MS) patients treated with natalizumab. This case highlights the variability of radiological findings in natalizumab-associated PML.

Area of Science:

  • Neuroimmunology
  • Neuroradiology
  • Infectious Neurology

Background:

  • Multiple Sclerosis (MS) is a chronic autoimmune disease of the central nervous system.
  • Natalizumab is an effective disease-modifying therapy for MS, but carries a risk of progressive multifocal leukoencephalopathy (PML).
  • Early diagnosis of PML is crucial for patient management.

Observation:

  • A case of a Multiple Sclerosis patient on natalizumab therapy is presented.
  • The patient developed progressive multifocal leukoencephalopathy (PML) with atypical magnetic resonance imaging (MRI) features.
  • The onset of PML occurred early in the course of treatment.

Findings:

  • PML can manifest with variable and atypical radiological patterns in natalizumab-treated MS patients.
  • The observed MRI features expanded the spectrum of known presentations of PML in this population.
  • This case underscores the importance of considering PML even with non-classical imaging findings.

Implications:

  • Radiologists and neurologists should consider a broader range of MRI patterns when diagnosing PML in natalizumab-treated MS patients.
  • Awareness of atypical presentations can aid in earlier detection and intervention.
  • This finding contributes to a better understanding of natalizumab-associated PML and its diverse clinical and radiological spectrum.
Keywords:
MRINatalizumabProgressive multifocal leukoencephalopathy

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