Journal
MULTIPLE SCLEROSIS JOURNAL
Volume 25, Issue 8, Pages 1196-1201Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/1352458519832259
Keywords
PML; alemtuzumab; TRECs; KRECs; T-cell receptor repertoire; B-cell receptor repertoire
Categories
Funding
- FISM-Fondazione Italiana Sclerosi Multipla-cod [2016/R/16]
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A 31-year-old woman affected by multiple sclerosis (MS) experienced generalized tonic-clonic seizures 2 months after the second alemtuzumab cycle. Positive JC virus (JCV)-DNA in cerebrospinal fluid (CSF) and lesion iconography at magnetic resonance imaging (MRI) were suggestive of progressive multifocal leukoencephalopathy (PML). After 1 month, during full-blown immune reconstitution inflammatory syndrome, JCV-DNA became negative and symptoms gradually improved. New T- and B-cell output and T- and B-cell diversity were low and lymphocytes poorly responded to stimulation. This is the first case of an alemtuzumab-treated patient with clinical symptoms and radiological features compatible with PML. The lack of large T- and B-cell diversity, necessary for JCV recognition, is likely to have concurred to PML insurgence.
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