Possible progressive multifocal leukoencephalopathy and active multiple sclerosis under dimethyl fumarate: the central role of MRI in informing therapeutic decisions

BMC Neurology

Giuseppe Pontillo¹  Elena Augusta Vola¹  Sirio Cocozza¹  Enrico Tedeschi¹  Maria Petracca²  Antonio Carotenuto²  Marcello De Angelis²  Vincenzo Brescia Morra²  Roberta Lanzillo² 

[1] Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy;Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy;

关键词: Progressive multifocal leukoencephalopathy;    Dimethyl fumarate;    Neuroimaging;    MRI;    Risk stratification;    Diagnostic criteria;    Case report;   

DOI  :  10.1186/s12883-021-02165-0

来源: Springer

【 摘 要 】

BackgroundProgressive multifocal leukoencephalopathy (PML) can rarely occur in Multiple Sclerosis (MS) patients undergoing dimethyl fumarate (DMF) treatment. Our case stresses the limits of current diagnostic and stratification risk criteria, highlighting the potential role of Magnetic Resonance Imaging (MRI) in advising clinical choices.Case presentationA 54 years old MS male patient treated with DMF, after 3 years of clinical stability developed a subacute clinical worsening. He had no severe lymphopenia but MRI signs suggestive of a coexistence of PML and MS activity. Although his viral title was negative, DMF was discontinued, with clinical and radiological improvement.ConclusionsThis case highlights the challenges behind PML diagnosis, especially in patients not fulfilling the risk stratification criteria and that might present with concurrent disease activity, stressing the potential role of MRI in informing therapeutic decisions.

【 授权许可】

CC BY