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Rituximab treatment did not aggravate ongoing progressive multifocal leukoencephalopathy in a patient with multiple sclerosis

Journal article
Authors Fredrik Asztely
E. Gilland
M. P. Wattjes
Jan Lycke
Published in Journal of the Neurological Sciences
Volume 353
Issue 1-2
Pages 155-157
ISSN 0022-510X
Publication year 2015
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
Pages 155-157
Language en
Links dx.doi.org/10.1016/j.jns.2015.04.01...
Keywords Multiple sclerosis, Natalizumab, Rituximab, Progressive multifocal leukoencephalopathy, JC virus, MRI, NATALIZUMAB-ASSOCIATED PML, THERAPY, Clinical Neurology, Neurosciences
Subject categories Infectious Medicine, Neurology

Abstract

A multiple sclerosis (MS) patient developed progressive multifocal leukoencephalopathy (PML) after 43 months of natalizumab treatment. New clinical and magnetic resonance imaging (MRI) findings were initially misinterpreted as breakthrough MS disease activity and natalizumab treatment was replaced by rituximab treatment The patient had a single infusion of rituximab 1000 mg before a definite PML diagnosis was confirmed. Despite undetectable levels of B-cells, JC virus DNA became undetectable in the cerebrospinal fluid by quantitative polymerase chain reaction. The patient partially recovered without any clinical or MRI signs of new MS activity. These findings suggest that B-cell depletion in a non-immune compromised individual did not prevent the patient from clearing the JC virus infection. (C) 2015 Elsevier B.V. All rights reserved.

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