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       #Post#: 742--------------------------------------------------
       (AAN)Tysabri-related PML w/recent negative JCV testing
       By: agate Date: April 27, 2015, 5:24 pm
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       A rare instance of a discussion of a patient with
       Tysabri-related PML--this time in someone whose JCV testing was
       negative.
       Presented at the annual AAN conference in Washington, DC:
       [quote]P4.030] Natalizumab-Related PML Is Possible Even With
       Recent Negative JCV Antibody Testing
       Marie-Sarah Brosseau, Gary Stobbe, Deb Cramer, Hillary Lipe,
       Annette Wundes
       Seattle, WA, USA.
       OBJECTIVE:
       To describe a case of progressive multifocal leukoencephalopathy
       (PML) in a patient on natalizumab who's last John Cunningham
       virus (JCV) antibody testing 2 weeks before onset of symptoms
       was negative.
       BACKGROUND:
       Natalizumab-related PML has a mortality of 22%, but many
       survivors have a poor functional outcome. An important PML risk
       factor is seropositivity for anti-JCV antibodies and serology
       should be retested periodically. Previously, 2
       natalizumab-treated multiple sclerosis PML patients were
       anti-JCV antibody negative but testing dated from 8 and 9 months
       before diagnosis.
       DESIGN/METHODS:
       Case presentation and literature review.
       RESULTS:
       A 70-year-old woman who had been on natalizumab for more than 4
       years and had never received immunosuppressants developed PML
       symptoms of progressive right arm weakness 2 weeks after last
       negative anti-JCV antibody testing (index value 0.19). The
       initial brain MRI was reported as having a new MS lesion but
       short-term repeat MRI raised the concern for PML and CSF JCV PCR
       came back positive. While prior routine JCV antibody retesting
       every 3 months per our clinic standard had been negative until 2
       weeks prior to onset of symptoms, at time of diagnosis serum
       anti-JCV antibody was positive with an index of 2.56.
       CONCLUSIONS:
       Negative anti-JCV antibody patients are still at risk for the
       development of PML because of the potential for de novo
       infection as well as possibly false negative test result, of
       which the reported rate is 3%.
       This case reiterates that any natalizumab-treated patient with
       new MRI lesions or new symptoms could have PML and suggests that
       JCV antibody should be repeated even if recently negative.
       Moreover, in such cases, short-term repeat MRI and/or CSF
       testing warrants consideration.
       ________
       Study Supported by: not supported
       Category - MS and CNS Inflammatory Disease: Clinical Science
       Session: P4: Poster Session IV: MS and CNS Inflammatory
       Diseases: Progressive Multifocal Leukoencephalopathy Risk (7:30
       AM-12:00 PM)
       Date/Time: Wednesday, April 22, 2015 - 7:30 am[/quote]
       The abstract can be seen here
  HTML http://www.abstracts2view.com/aan/view.php?nu=AAN15L1_P4.030.
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