, Volume 24, Issue 2, pp 173-176
Date: 27 Mar 2013

A Case of Natalizumab-associated Progressive Multifocal Leukoencephalopathy—Role for Advanced MRI?

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A 38-year-old Caucasian female with relapsing–remitting multiple sclerosis developed motor aphasia after 25 infusions of natalizumab in August 2010. The finding of subacute motor aphasia was suggestive of progressive multifocal leukoencephalopathy (PML). A T2-weighted 1.5 T MRI scan (Signa, GE Healthcare, Waukesha, WI, USA) showed white matter lesions in the left parietal lobe, T1-weighted contrast-enhanced images revealed garland-like structures in the left periventricular area and in the right occipital area (Fig. 1ac). These findings did not provide clear evidence for PML. Despite diagnostic uncertainty, treatment with natalizumab was finished and five cycles of plasma separation were applied. The laboratory confirmation of PML was available two weeks after the treatment was initiated (1 copy/ml of JCV DNA in the first test, 103 copies/ml of JCV DNA in the second test). There was a slight deterioration of aphasia within the next days.

Fig. 1

1.5 T MRI (ac) performed in August 2010 a