期刊
NEW ENGLAND JOURNAL OF MEDICINE
卷 361, 期 11, 页码 1081-1087出版社
MASSACHUSETTS MEDICAL SOC
DOI: 10.1056/NEJMoa0810316
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资金
- Swedish Research Council
- European Union's Sixth Framework Program [LSHM-CT-2005-018637]
- Bibbi and Niels Jensens Foundation
- Sderberg Foundation
We describe progressive multifocal leukoencephalopathy (PML) caused by infection with human polyomavirus JC virus in a patient with multiple sclerosis who was treated with natalizumab. The first PML symptoms appeared after 14 monthly infusions of the drug. Magnetic resonance imaging (MRI) showed a presumed multiple sclerosis lesion, and JC virus DNA was not detected on polymerase-chain-reaction (PCR) assay of cerebrospinal fluid. The patient's symptoms worsened, and the diagnosis of PML was established with a more sensitive quantitative PCR assay after 16 infusions of natalizumab. Plasma exchange was used to accelerate clearance of natalizumab. Approximately 3 weeks after plasma exchange, an immune-reconstitution inflammatory syndrome appeared. JC virus DNA was no longer detectable on quantitative PCR assay, and the patient's symptoms improved.
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