Natalizumab, a treatment used in multiple sclerosis (MS), is associated with cases of progressive multifocal leukoencephalopathy (PML).
Objective:
We describe two cases of PML in related but not genetically apparented natalizumab-treated MS patients who are stepsisters.
Reported cases/outcomes:
While Patient 1 developed PML, Patient 2 was on natalizumab and had contacts with Patient 1. Patient 2 was diagnosed with PML 5 months after Patient 1.
Conclusion:
The clinical and temporal data highly suggest that there was JC virus (JCV) transmission from one patient to the other with development of PML as primo-infection in Patient 2.
TanCSKoralnikIJ.Progressive multifocal leukoencephalopathy and other disorders caused by JC virus: Clinical features and pathogenesis. Lancet Neurol2010; 9: 425–437.
2.
KnowlesWA.Discovery and epidemiology of the human polyomaviruses BK virus (BKV) and JC virus (JCV). Adv Exp Med Biol2006; 577: 19–45.
3.
GorelikLLernerMBixlerS. Anti-JC virus antibodies: Implications for PML risk stratification. Ann Neurol2010; 68: 295–303.
4.
GheuensSWuthrichCKoralnikIJ.Progressive multifocal leukoencephalopathy: Why gray and white matter. Annu Rev Pathol2013; 8: 189–215.
5.
HavlaJBertheleAKumpfelT. Co-occurrence of two cases of progressive multifocal leukoencephalopathy in a natalizumab “infusion group.”Mult Scler2013; 19: 1213–1215.
6.
ViscidiRPKhannaNTanCS. JC virus antibody and viremia as predictors of progressive multifocal leukoencephalopathy in human immunodeficiency virus-1-infected individuals. Clin Infect Dis2011; 53: 711–715.
7.
Bofill-MasSGironesR.Excretion and transmission of JCV in human populations. J Neurovirol2001; 7: 345–349.
8.
YogoYZhongSShibuyaA. Transcriptional control region rearrangements associated with the evolution of JC polyomavirus. Virology2008; 380: 118–123.
9.
PfisterL-ALetvinNLKoralnikIJ.JC virus regulatory region tandem repeats in plasma and central nervous system isolates correlate with poor clinical outcome in patients with progressive multifocal leukoencephalopathy. J Virol2001; 75: 5672–5676.
10.
AzziADe SantisRCiappiS. Human polyomaviruses DNA detection in peripheral blood leukocytes from immunocompetent and immunocompromised individuals. J Neurovirol1996; 2: 411–416.
11.
Du PasquierRAKurodaMJZhengY. A prospective study demonstrates an association between JC virus-specific cytotoxic T lymphocytes and the early control of progressive multifocal leukoencephalopathy. Brain2004; 127: 1970–1978.
