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   DIR Return to: TYSABRI (natalizumab)
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       #Post#: 271--------------------------------------------------
       MS patient on Tysabri turns out to have Creutzfeldt-Jakob
       disease, not PML
   DIR By: agate
       Date: April 28, 2014, 3:05 pm
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       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:
       --- Quote ---
       > 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.
       --- End Quote ---
       The entire article can be seen here
  HTML http://nn.neurology.org/content/1/1/e1.full.
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