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Cerebral abscess in a multiple sclerosis patient during treatment with natalizumab

  • B. DurmusEmail author
  • J. Van Goethem
  • A. Vercruyssen
  • G. De la Meilleure
  • C. Jadoul
  • B. Willekens
Letter to the Editor

Dear Editor,

Natalizumab is a monoclonal antibody against α4-integrin and inhibits lymphocyte transmigration across the blood brain barrier [1]. This treatment is highly efficacious in relapsing–remitting multiple sclerosis (RRMS) but associated with a higher risk of developing central nervous system (CNS) infections [2]. We describe a case of a long-term natalizumab-treated RRMS patient who developed a cerebral abscess.

Case report

A 40-year-old male was diagnosed with RRMS in 2006 and switched from interferon-beta 1a to natalizumab due to ongoing clinical and magnetic resonance imaging (MRI) disease activity in 2008. Since then, his disease remained stable, both clinically and radiographically. In 2018, 9 days after the last natalizumab infusion and 18 days after the last brain MRI—demonstrating an unchanged lesion load—he presented to the emergency room (ER) with a first generalized epileptic seizure. The preceding weeks he had suffered from a flu-like syndrome with sore throat....

Keywords

Natalizumab Abscess Bacterial infection Multiple sclerosis Immune system 

Notes

Author contributions

BD drafted the original manuscript. AV, GdlM, CJ and BW provided critical revision of the manuscript for intellectual content. JvG provided additionally radiographic figures. All the authors gave final approval of the version to be published.

Compliance with ethical standards

Conflict of interest

Busra Durmus, Johan van Goethem, Alex Vercruyssen and Chris Jadoul reported no disclosures. Barbara Willekens: the institution (Antwerp University Hospital) received fees for speaking, consultancy and grants from Biogen, Sanofi-Genzyme, Roche, Novartis and Merck Serono. All fees are used for research purposes. BW received travel support from Biogen, Teva, Sanofi, Roche, Novartis and Merck Serono. Gino de la Meilleure: He received fees for speaking, consultancy, travel support and research from Biogen, Sanofi-Genzyme, Roche, Novartis, Merckx and Teva.

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Copyright information

© Belgian Neurological Society 2019

Authors and Affiliations

  • B. Durmus
    • 1
    Email author
  • J. Van Goethem
    • 2
    • 3
  • A. Vercruyssen
    • 1
  • G. De la Meilleure
    • 1
  • C. Jadoul
    • 1
  • B. Willekens
    • 4
    • 5
  1. 1.Department of NeurologyAZ NikolaasSint-NiklaasBelgium
  2. 2.Department of RadiologyAZ Nikolaas, Moerlandstraat 1, 9100Sint-NiklaasBelgium
  3. 3.Department of Radiology, Antwerp University HospitalEdegemBelgium
  4. 4.Department of NeurologyAntwerp University HospitalWilrijkstraat 10, 2650 EdegemBelgium
  5. 5.Laboratory of Experimental HematologyUniversity of AntwerpEdegemBelgium

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