A 52-year-old man with primary progressive MS on natalizumab for 2 years develops progressive weakness and cognitive decline. New brain MRI shows multiple cavitary white matter lesions with surrounding edema. Serum JC virus antibody is positive and CSF JC virus PCR is negative. Which of the following is the most appropriate next step?
- A)Continue natalizumab and obtain repeat CSF in 1 month
- B)Perform brain biopsy for definitive diagnosis
- C)Discontinue natalizumab immediatelyGABARITO
- D)Add corticosteroids and continue natalizumab
- E)Increase natalizumab dose
Explicação
Natalizumab significantly increases risk of progressive multifocal leukoencephalopathy (PML), particularly in JC virus-seropositive patients, after prolonged use (>2 years), and in those receiving prior immunosuppression. The clinical presentation (progressive... Ver explicação completa e trilha adaptativa →