Herpes encephalitis during natalizumab treatment in multiple sclerosis

PRES Lille Nord de France, Université Catholique de Lille, Groupe Hospitalier de l'Institut Catholique de Lille, Faculté Libre de Médecine, Clinique de Neurologie, Lille, France.
Multiple Sclerosis (Impact Factor: 4.82). 11/2011; 18(6):909-11. DOI: 10.1177/1352458511428082
Source: PubMed


In this case report we describe the first non-fatal herpes simplex virus encephalitis (HSE) case with natalizumab for multiple sclerosis (MS). A 36-year-old woman, previously treated with immunomodulatory and immunosuppressive drugs for MS, developed acute encephalitis after 6 monthly natalizumab perfusions. Brain imaging demonstrated suggestive bi-temporal lesions. Herpes simplex virus type-1 DNA was detected in cerebrospinal fluid. The patient improved gradually after a 21-day course of intravenous acyclovir, but neuropsychiatric changes remained 5 months later. Our non-fatal case of HSE and other reported cases of herpes infections provide evidence of an increased risk with natalizumab and point to the need for clinicians to maintain awareness.

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    • "No increased risk of lymphoma, malignant melanoma or hypereosinophilia was reported in these studies [Abbas et al. 2011; Bujold et al. 2014; Mullen et al. 2008]. No increase in infection among patients receiving natalizumab, compared with placebo, was found [Polman et al. 2006; Rudick et al. 2006], but postmarketing studies identified a slight excess of herpes virus infections [Fine et al. 2013; Holmen et al. 2011] with rare cases of fatal herpes encephalitis [Biogen Idec, 2013; Kwiatkowski et al. 2012] and meningitis [Biogen Idec, 2013; Shenoy et al. 2011; Valenzuela et al. 2014]. "
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    • "HHV-6 is commonly reactivated in situations of immunosuppression and has been associated with MS.70 Several lines of evidence, including an increase in the level of HHV-6-specific antibodies in serum and an increase in HHV-6 DNA in the cerebrospinal fluid of natalizumab-treated MS patients, suggest that HHV-6 might reactivate on treatment with natalizumab.71,72 Herpes simplex and varicella zoster CNS infections have recently been reported in 20 natalizumab-treated MS patients.73,74 Finally, a single case of ocular toxoplasmosis has been reported after 11 months of treatment with natalizumab.75 "
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