A 29-year-old woman with newly diagnosed multiple sclerosis is started on natalizumab. After 14 months of treatment, she develops progressive confusion, memory loss, and gait disturbance. Brain MRI shows new asymmetric white matter lesions without enhancement. CSF JC virus PCR is negative but remains negative on repeat. Which of the following is most likely?
- A)Progressive multifocal leukoencephalopathyGABARITO
- B)Immune reconstitution inflammatory syndrome
- C)MS disease breakthrough
- D)Posterior reversible encephalopathy syndrome
- E)Natalizumab-associated IRIS
Explicação
PML can occur with natalizumab, typically after 2 years but may occur earlier. Progressive cognitive decline, asymmetric white matter lesions, and timing on natalizumab are consistent with PML. Importantly, CSF JC virus PCR can be negative in up to 10% of PML ... Ver explicação completa e trilha adaptativa →