Progressive Multifocal Leukoencephalopathy after Natalizumab Therapy for Crohn's Disease

• Published in: The New England journal of medicine Vol. 353; no. 4; pp. 362 - 368
• Main Authors: Van Assche, Gert, Van Ranst, Marc, Sciot, Raf, Dubois, Bénédicte, Vermeire, Séverine, Noman, Maja, Verbeeck, Jannick, Geboes, Karel, Robberecht, Wim, Rutgeerts, Paul
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 28.07.2005
• Subjects: Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Astrocytoma - diagnosis; Biological and medical sciences; Brain - pathology; Brain - virology; Brain Neoplasms - diagnosis; Crohn Disease - drug therapy; Crohns disease; Diagnostic Errors; DNA, Viral - blood; Drug therapy; Fatal Outcome; General aspects; Genotype; Human viral diseases; Humans; Infectious diseases; Integrin alpha4 - immunology; JC virus; JC Virus - genetics; JC Virus - isolation & purification; Leukemia; Leukocyte Count; Leukoencephalopathy, Progressive Multifocal - chemically induced; Leukoencephalopathy, Progressive Multifocal - pathology; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Monoclonal antibodies; Natalizumab; Neurological disorders; Opportunistic Infections - chemically induced; Opportunistic Infections - pathology; Polyomavirus; Viral diseases; Viral diseases of the nervous system; Viral Load; Nervous system diseases; Natalizumab; Monoclonal antibody; Cerebral disorder; Inflammatory disease; Progressive multifocal leukoencephalopathy; Infection; Virus; Immunomodulator; Medicine; Crohn disease; Treatment; Viral disease; Central nervous system disease; Digestive diseases; Intestinal disease; Slow virus
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa051586

In a man with Crohn's disease who was treated with natalizumab and subsequently died, reexamination showed that the fatal lesion was progressive multifocal leukoencephalopathy and not an astrocytoma. Analysis of serial serum specimens showed that JC virus first appeared about three months after the initiation of natalizumab therapy. In a man with Crohn's disease who was treated with natalizumab and subsequently died, reexamination showed that the fatal lesion was progressive multifocal leukoencephalopathy. Natalizumab has great therapeutic potential in both multiple sclerosis and inflammatory bowel disease. 1 – 3 Two cases of progressive multifocal leukoencephalopathy (PML) have recently been reported in patients with multiple sclerosis who were treated with a humanized monoclonal antibody against α 4 integrins, natalizumab (Tysabri, Elan and Biogen Idec), in combination with interferon beta-1a (Avonex, Biogen Idec). 4 One of these cases is described elsewhere in this issue of the Journal . 5 We report a third case of PML — this one in a patient with Crohn's disease who received 300 mg of open-label natalizumab intravenously every four weeks as part of . . .