Immune reconstitution inflammatory syndrome and natalizumab-Is it possible before removing the drug?

Autor: Mulero P; Neurology Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, ZP: 47005, Castilla y León, Valladolid, Spain. Electronic address: pamuca84@hotmail.com., Neri MJ; Neurology Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, ZP: 47005, Castilla y León, Valladolid, Spain., Rodriguez M; Radiology Department, Hospital Clínico Universitario de Valladolid, Castilla y León, Spain., Arenillas JF; Neurology Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, ZP: 47005, Castilla y León, Valladolid, Spain., Téllez N; Neurology Department, Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, ZP: 47005, Castilla y León, Valladolid, Spain.
Jazyk: angličtina
Zdroj: Multiple sclerosis and related disorders [Mult Scler Relat Disord] 2014 Sep; Vol. 3 (5), pp. 659-61. Date of Electronic Publication: 2014 Jul 21.
DOI: 10.1016/j.msard.2014.07.001
Abstrakt: Multiple sclerosis (MS) patients treated with natalizumab have a significant reduction in annualized relapse rate; in these patients, a relapse is uncommon but not unexpected. In contrast, the appearance of a severe exacerbation is striking and requires the differential diagnosis with progressive multifocal leukoencephalopathy. Here, we describe a case of a 22-year-old woman with relapsing-remitting MS who developed an unexpected response after the patient׳s fifth natalizumab infusion with an aggressive radiological and clinical evolution. Changing the patient׳s treatment to fingolimod resulted in the absence of new clinical relapses and the absence of active lesions on brain magnetic resonance images (MRI) during the first 12 months of follow-up. We hypothesize that the appearance of natalizumab antibodies in this patient triggered lymphocyte migration to the central nervous system in a rebound phenomenon; this is similar to what occurs during immune reconstitution inflammatory syndrome (IRIS) after removal of natalizumab.
(Copyright © 2014 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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