A 33-year-old woman with relapsing-remitting MS on natalizumab therapy presents with progressive cognitive decline and personality changes over 3 months. Vital signs: BP 118/76, HR 88, RR 16, Temp 37.2°C, SpO2 98%. Brain MRI reveals a new frontal lobe lesion with peripheral edema. CSF analysis shows JC virus DNA; protein is normal. She denies fever or focal neurologic deficits. Which complication has developed?
- A)Secondary progressive multiple sclerosis
- B)CNS lymphoma from immunosuppression
- C)Natalizumab-induced encephalitis
- D)MS relapse with cognitive impairment
- E)Progressive multifocal leukoencephalopathyGABARITO
Explicação
PML is the most serious complication of natalizumab, occurring in 1 in 1000 patients. Detection of JC virus DNA in CSF is diagnostic. Progressive cognitive decline and behavioral changes with unusual MRI lesion appearance in frontal lobe are classic PML presen... Ver explicação completa e trilha adaptativa →