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       #Post#: 1878--------------------------------------------------
       (Abst.) Pathologic findings of chronic PML-IRIS in patient w/pro
       longed PML survival after Tysabri
       By: agate Date: November 7, 2017, 8:11 pm
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       From PubMed, October 11, 2017:
       [quote]Pathologic Findings of Chronic PML-IRIS in a Patient with
       Prolonged PML Survival Following Natalizumab Treatment
       Himedan M1, Camelo-Piragua S1, Mills EA1, Gupta A1, Aburashed
       R2, Mao-Draayer Y1.
       Author information
       1
       University of Michigan, Ann Arbor, MI, USA.
       2
       Michigan State University, East Lansing, MI, USA.
       Immune reconstitution inflammatory syndrome (IRIS) is a common
       complication during treatment for natalizumab-associated
       progressive multifocal leukoencephalopathy (PML). Although
       severe IRIS can result in acute worsening of disability and is
       associated with poor prognosis, effective immune reconstitution
       may account for the high survival rate of this cohort of PML
       patients.
       We present pathological evidence of chronic IRIS 3.5 years after
       diagnosis with natalizumab-associated PML. Our case showed that
       the IRIS initially developed after plasma exchange therapy and
       resolved clinically and radiologically following a combination
       treatment with corticosteroids, maraviroc, and cidofovir.
       Autopsy 3.5 years later revealed evidence of grey-white matter
       junction demyelinating lesions characteristic of PML and
       perivascular leukocyte infiltrates predominated by CD8+
       T-lymphocytes, and polymerase chain reaction analysis
       demonstrated the presence of JC viral DNA in this tissue,
       indicative of persistent PML-IRIS.
       While clinical symptoms of PML-IRIS typically stabilize within 6
       months, our case report suggests that prolonged low-grade
       inflammation may persist in some patients. Better assays are
       needed to determine the prevalence of prolonged low-grade IRIS
       among PML survivors.[/quote]
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