Fatal neuroinflammation in a case of multiple sclerosis with anti-natalizumab antibodies

Abstract

A 32-year-old woman presented with multiple sclerosis (MS) in 2001, displaying typical MS features on MRI and in the CSF. The patient's clinical condition was relatively stable without major exacerbations on interferon beta-1a but MRI investigation in September 2007 noted a significant progression in lesions (figure, A) but without contrast enhancement, indicating no loss of blood-brain barrier (BBB) integrity. The patient commenced natalizumab immunotherapy in November 2007 (300 mg every fourth week). At this point, she presented with an Extended Disability Status Scale score estimated at 3.0 and complaint of some memory and concentration problems.