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

Progressive 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)...

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Published inBMC neurology Vol. 21; no. 1; p. 146
Main Authors Vola, Elena Augusta, Petracca, Maria, Cocozza, Sirio, De Angelis, Marcello, Carotenuto, Antonio, Pontillo, Giuseppe, Morra, Vincenzo Brescia, Tedeschi, Enrico, Lanzillo, Roberta
Format Journal Article
LanguageEnglish
Published England BioMed Central Ltd 05.04.2021
BioMed Central
BMC
Subjects
Ataxia
Case Report
Case studies
Coexistence
Diagnosis
Diagnostic criteria
Dimethyl fumarate
Drug therapy
Dysarthria
Leukoencephalopathy
Leukoencephalopathy, Progressive multifocal
Lymphopenia
Magnetic resonance imaging
Medical imaging
MRI
Multiple sclerosis
Neuroimaging
Patients
Polymerase chain reaction
Progressive multifocal leukoencephalopathy
Risk factors
Risk stratification
Italy
Neuroimaging
Case report
Diagnostic criteria
MRI
Dimethyl fumarate
Risk stratification
Progressive multifocal leukoencephalopathy
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Summary:Progressive 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. A 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. This 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.
Bibliography:ObjectType-Case Study-2
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ISSN:1471-2377
1471-2377
DOI:10.1186/s12883-021-02165-0