Partial recovery after severe immune reconstitution inflammatory syndrome in a multiple sclerosis patient with progressive multifocal leukoencephalopathy

Alberto Calvi, Milena De Riz, Anna M. Pietroboni, Laura Ghezzi, Virginia Maltese, Andrea Arighi, Giorgio G. Fumagalli, Francesca Jacini, Carlotta Donelli, Giancarlo Comi, Daniela Galimberti, Elio Scarpini

Research output: Contribution to journalArticle

Abstract

Progressive multifocal leukoencephalopathy (PML) is a rare and severe complication of natalizumab therapy in patients with multiple sclerosis and it may be accompanied by immune reconstitution inflammatory syndrome (IRIS). Here, we describe a case of abnormally severe IRIS, which occurred 2 months after natalizumab-associated PML in a 38-year-old woman affected by multiple sclerosis. The patient was John Cunningham virus-positive and was treated for 21 months when she developed PML. The subsequent IRIS diffusely afflicted the brain, producing edema and signs of intracranial hypertension, with a clinically severe form compromising the state of consciousness, requiring intensive care and high-dosage steroid treatment. Nevertheless, she survived and partially recovered. There is still difficulty in differentiating PML progression from IRIS onset and there is not a clear description in the literature about different clinical forms of IRIS, prognostic factors and guidelines to properly treat this complication in order to reduce the residual disability of the patient surviving this treatment complication.

Original languageEnglish
Pages (from-to)23-28
Number of pages6
JournalImmunotherapy
Volume6
Issue number1
DOIs
Publication statusPublished - 2014

Keywords

  • immune reconstitution inflammatory syndrome
  • JC virus
  • multiple sclerosis
  • natalizumab
  • progressive multifocal leukoencephalopathy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Oncology
  • Immunology

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