Asymptomatic progressive multifocal leukoencephalopathy: a case report and review of the literature

Table 1 Case reports of natalizumab-associated progressive multifocal leukoencephalopathy with asymptomatic disease course

Authors and Reference number	Age (years)/sex	EDSS at diagnosis	MRI findings	Development of IRIS	PML treatment	CSF JCV (copies/ml)	Risk factors [11]
This case report	26/F	0	Bilateral asymmetric confluent non-enhancing hyperintensities in the bilateral subcortical precentral gyri	Yes	Mefloquine and mirtazapine	15	27 natalizumab infusions, JCV-positive, JCV index 3.58
Blinkenberg et al. [12]	50/F	3.5	Right cerebellar peduncle hyperintense lesions	Yes	None, PML undiagnosed until presentation of PML-IRIS following natalizumab cessation	552	47 natalizumab infusions, JCV-positive
Fabis-Pedrini et al. [13]	24/F	6	Mildly enhancing small patchy lesions in left brainstem, cerebral peduncle, pontine tegmentum, and left brachium points	Yes	PLEX, mefloquine, mirtazapine, prednisone	63,910	Treatment with natalizumab for 54 months, JCV-positive
Mc Govern and Hennessay [14]	61/F	0	Left posterior parietal non-enhancing hyperintensity	No	PLEX, mirtazapine	12	Treatment with natalizumab for 3 years

CSF cerebrospinal fluid, EDSS Expanded Disability Status Scale, F female, IRIS immune reconstitution inflammatory syndrome, JCV John Cunningham virus, MRI magnetic resonance imaging, PLEX plasma exchange, PML progressive multifocal leukoencephalopathy

ISSN: 1752-1947