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PML-IRIS during Fingolimod Diagnosed after Natalizumab Discontinuation
J Killestein1, A Vennegoor1, A E L van Golde2
1Department of Neurology, MS Center Amsterdam, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
Case Reports in Neurological Medicine
|December 16, 2014
Summary
Natalizumab-treated multiple sclerosis patients require vigilant MRI monitoring post-discontinuation. A missed progressive multifocal leukoencephalopathy (PML) case highlights risks with alternative therapies like Fingolimod.
Area of Science:
- Neuroimmunology
- Neuro-oncology
- Pharmacovigilance
Background:
- Natalizumab is frequently discontinued in multiple sclerosis (MS) patients due to progressive multifocal leukoencephalopathy (PML) risk.
- Alternative medications are often initiated following Natalizumab cessation.
Purpose of the Study:
- To report a case of missed PML on MRI during Natalizumab discontinuation.
- To highlight the potential for PML-immune reconstitution inflammatory syndrome (IRIS) with subsequent therapies.
Main Methods:
- Case report detailing a multiple sclerosis patient's treatment history.
- Magnetic resonance imaging (MRI) surveillance during and after Natalizumab therapy.
Main Results:
- A case of PML was initially missed on MRI upon Natalizumab discontinuation.
- The patient developed PML-IRIS after initiating Fingolimod, indicating immune reconstitution during lymphopenia.
Conclusions:
- Strict MRI surveillance is crucial for Natalizumab-treated MS patients at drug discontinuation and thereafter.
- This vigilance is essential for pharmacovigilance of both Natalizumab and subsequent treatments.
