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Cryptococcal meningitis in a multiple sclerosis patient taking natalizumab
Reuben Mari Valenzuela1, John H Pula1, Dennis Garwacki1
1Department of Neurology, University of Illinois College of Medicine, Illinois Neurologic Institute, Department of Medicine, Peoria, United States.
Journal of the Neurological Sciences
|April 1, 2014
Summary
This case report details the first instance of cryptococcal meningitis in a patient treated with natalizumab for multiple sclerosis (MS). Management involved discontinuing natalizumab, antifungal therapy, and later steroids for an MS relapse.
Area of Science:
- Neurology
- Infectious Diseases
Background:
- Natalizumab is an FDA-approved treatment for multiple sclerosis (MS) but carries risks including progressive multifocal leukoencephalopathy (PML) and other serious infections.
- Adverse events associated with natalizumab include melanoma, CNS lymphoma, and cryptosporidiosis, with potential for MS exacerbation or immune reconstitution inflammatory syndrome (IRIS) upon discontinuation.
Observation:
- A 49-year-old man with relapsing-remitting MS on natalizumab developed cryptococcal meningitis after 24 months of treatment.
- Natalizumab was discontinued, and the patient initiated antifungal therapy. Cerebrospinal fluid tests for JC virus and HIV were negative.
Findings:
- The patient experienced an MS exacerbation two months after natalizumab discontinuation while on antifungal treatment.
- Treatment included conventional antifungal therapy and steroids for the MS relapse, leading to improvement in both conditions.
Implications:
- This case highlights the potential for rare opportunistic infections like cryptococcal meningitis in natalizumab-treated patients.
- Effective management requires addressing both the opportunistic infection and potential MS relapses after natalizumab cessation.
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