MS Speaks

Reporting a case of an MS patient on Tysabri who converted to JCV+ during treatment who developed unusual symptoms that were initially thought to be PML, but the diagnosis turned out to be Creutzfeldt-Jakob disease.

Extract from the new AAN open-access journal, Neurology, Neuroimmunology, & Neuroinflammation, April 29, 2014:

Unusual deterioration in a patient with multiple sclerosis on natalizumab therapy

Thomas Gattringer, MD, Christian Enzinger, MD, Michael Khalil, MD, PhD, Petra Schwingenschuh, MD, Alexander Pichler, MD, Alexander Moser, MD, Winfried Graninger, MD, Christina Ernst, MSc, Johannes Haybaeck, MD, PhD and Franz Fazekas, MD

From the Department of Neurology (T.G., C. Enzinger, M.K., P.S., A.P., F.F.), Division of Neuroradiology, Department of Radiology (C. Enzinger), Division of Rheumatology and Immunology, Department of Internal Medicine (W.G.), and Department of Neuropathology, Institute of Pathology (C. Ernst, J.H.), Medical University of Graz, Graz, Austria; and Neurorehabilitation Clinic Kapfenberg (A.M.), Kapfenberg, Austria.

Correspondence to Dr. Gattringer: thomas.gattringer@medunigraz.at
doi: 10.1212/NXI.0000000000000001


Natalizumab is an effective treatment in patients with highly active relapsing-remitting multiple sclerosis (RRMS). However, its positive therapeutic effects have to be weighed against the potential serious adverse event of progressive multifocal leukoencephalopathy (PML). Thus, whenever patients with MS on natalizumab develop uncommon and progressive neurologic symptoms, the suspicion of PML has to be raised. The risk of PML becomes higher with increasing duration of natalizumab treatment, prior immunosuppressive treatment, and JC virus (JCV) antibody seropositivity. We here report a case of MS in which unusual symptoms in the context of 5 years of natalizumab treatment and seroconversion to JCV antibody positivity led to the initial suspicion of PML and a final diagnosis of Creutzfeldt-Jakob disease (CJD).




Study funding:

No targeted funding reported.
Disclosure: T. Gattinger reports no disclosures. C. Enzinger has served on the advisory boards for Biogen Idec, Bayer-Schering, Merck-Serono, Novartis, and Teva Ratiopharm; has received travel grants and speaking honoraria from Biogen Idec, Teva-Aventis, Merck-Serono, Bayer-Schering, and Novartis; is on the editorial advisory board for PlosOne; is a consultant for Biogen Idec, Merck-Serono, and Bayer-Schering; and has received unrestricted research grants from Teva-Aventis, Biogen Idec, and Merck-Serono. M. Khalil has received honoraria from Bayer-Schering Pharma. P. Schwingenschuh served on national advisory boards for UCB and Novartis Austria; received funding from Boehringer-Ingelheim, Ipsen, Allergan, UCB, and Merz Pharma; and received speaker honoraria from UCB, Lundbeck, and Ipsen. A. Pichler, A. Moser, W. Graninger, C. Ernst, and J. Haybaeck report no disclosures. F. Fazekas has been an advisor for Bayer-Schering, Biogen Idec, Bristol-Myers Squibb, Genzyme, Merck-Serono, Novartis, Perceptive Informatics, Pfizer, Teva-Aventis, Teva Pharmceuticals LTD, and D-Pharm LTD; has been a member of DSMB; has received honoraria from Bayer-Schering, Biogen Idec, Merck-Serono, Novartis, Sanofi-Aventis, and Teva Pharmaceuticals Ltd; is on the editorial board for Cerebrovascular Diseases, Journal of Neurology, Polish Journal of Neurology and Neurosurgery, Stroke, Swiss Archives of Neurology and Psychiatry, and Multiple Sclerosis; and was on the speakers' bureau for Bayer-Schering and Merck-Serono.

The entire article can be seen here.