Use of interleukin-2 for management of natalizumab-associated progressive multifocal leukoencephalopathy: Case report and review of literature

Divyanshu Dubey, Yinan Zhang, Donna Graves, Allen D. DeSena, Elliot Frohman, Benjamin Greenberg

Research output: Contribution to journalReview article

7 Citations (Scopus)

Abstract

A 51-year-old woman with relapsing-remitting multiple sclerosis (RRMS) and 3-year history of natalizumab use developed expressive aphasia. A brain magnetic resonance image (MRI) showed left frontotemporal and right parietal lesion with mild contrast enhancement and cerebrospinal fluid (CSF) was positive for John Cunningham virus (JCV) by polymerase chain reaction (PCR). The patient received five cycles of plasmapheresis followed by intravenous immunoglobulin. Despite this intervention, her speech deteriorated and she developed right hemiparesis. Upon referral to our institution, CSF quantitative JCV PCR was notable for 834 copies/ml. The patient was given an initial dose of 50,000 units of interleukin-2 (IL-2) subcutaneously (SQ) followed by 1 million units IL-2 SQ daily. Due to concern for immune reconstitution inflammatory syndrome (IRIS), the patient also received intravenous methylprednisone weekly. The regimen was tolerated well by the patient with no severe adverse effects. Clinically, the patient showed some improvement, and became more responsive and regained right lower extremity antigravity strength. After 12 weeks of IL-2 therapy, JCV quantitative PCR was notable for 31 copies/ml and the patient was more responsive. Due to persistence of JCV, IL-2 therapy was changed to mefloquine. At follow up after 6 months, the patient showed no clinical deterioration.

Original languageEnglish (US)
Pages (from-to)211-215
Number of pages5
JournalTherapeutic Advances in Neurological Disorders
Volume9
Issue number3
DOIs
StatePublished - May 1 2016
Externally publishedYes

Fingerprint

Progressive Multifocal Leukoencephalopathy
Interleukin-2
JC Virus
Polymerase Chain Reaction
Cerebrospinal Fluid
Immune Reconstitution Inflammatory Syndrome
Broca Aphasia
Mefloquine
Relapsing-Remitting Multiple Sclerosis
Plasmapheresis
Intravenous Immunoglobulins
Paresis
Natalizumab
Lower Extremity
Magnetic Resonance Spectroscopy
Referral and Consultation
Brain
Therapeutics

Keywords

  • Immune Reconstitution Inflammatory Syndrome
  • Interleukin-2
  • Multiple sclerosis
  • Natalizumab
  • Progressive multifocal leukoencephalopathy

ASJC Scopus subject areas

  • Pharmacology
  • Neurology
  • Clinical Neurology

Cite this

Use of interleukin-2 for management of natalizumab-associated progressive multifocal leukoencephalopathy : Case report and review of literature. / Dubey, Divyanshu; Zhang, Yinan; Graves, Donna; DeSena, Allen D.; Frohman, Elliot; Greenberg, Benjamin.

In: Therapeutic Advances in Neurological Disorders, Vol. 9, No. 3, 01.05.2016, p. 211-215.

Research output: Contribution to journalReview article

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