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Malaysian Journal of Medical Sciences
School of Medical Sciences, Universiti Sains Malaysia
ISSN: 1394-195X
Vol. 23, No. 5, 2016, pp. 91-95
Bioline Code: mj16067
Full paper language: English
Document type: Case Report
Document available free of charge

Malaysian Journal of Medical Sciences, Vol. 23, No. 5, 2016, pp. 91-95

 en Natalizumab-Related Progressive Multifocal Leukoencephalopathy-Immune Reconstitution Inflammatory Syndrome: A Case Report Highlighting Clinical and MRI Features
Purohit, Bela; Ganewatte, Eranga & Kollias, Spyros S.


Multiple sclerosis (MS) patients treated with natalizumab often face the uncommon but severe complication of developing progressive multifocal leukoencephalopathy (PML). PML may be further complicated by immune reconstitution inflammatory syndrome (IRIS) after the removal of the drug. Since both PML and IRIS are associated with high morbidity and mortality rates, early clinical and radiological diagnosis of these complications is of paramount importance. Here, we report a case of an adult male patient who was diagnosed with PML after receiving natalizumab therapy for 6 years for the treatment of MS. Upon cessation of natalizumab, he presented with a paradoxical worsening of clinical and radiological findings consistent with an inflammatory brain injury due to IRIS. He was treated with high dose corticosteroid therapy followed by a gradual improvement in clinical and imaging findings. This article illustrates the magnetic resonance imaging (MRI) features of natalizumab‑associated PML-IRIS, along with a brief overview of its clinical features, complications and management strategies.

magnetic resonance imaging; natalizumab; multiple sclerosis; progressive multifocal leukoencephalopathy; immune reconstitution inflammatory syndrome

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