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Progressive multifocal leucoencephalopathy

M T Tang, M E Keir, R Erickson, E G Stefanich, F K Fuh, T Ramirez-Montagut, J M McBride, D M Danilenko
BACKGROUND: Novel treatments with superior benefit-risk profiles are needed to improve the long-term prognosis of patients with inflammatory bowel disease (IBD). Etrolizumab-a monoclonal antibody that specifically targets β7 integrins-is currently under phase III clinical evaluation in IBD. AIM: This review summarises the available pharmacological and pharmacokinetic/pharmacodynamic data for etrolizumab to provide a comprehensive understanding of its mechanism of action (MOA) and pharmacological effects...
March 30, 2018: Alimentary Pharmacology & Therapeutics
Paolo Bigliano, Andrea Calcagno, Anna Lucchini, Sabrina Audagnotto, Chiara Montrucchio, Letizia Marinaro, Chiara Alcantarini, Valeria Ghisetti, Giovanni Di Perri, Stefano Bonora
BACKGROUND: HIV late presenters are at high risk of Cytomegalovirus reactivation and end-organ disease. CMV viremia has been associated with poor survival but the effect of anti-CMV treatment has not been studied in this setting. METHODS: HIV-positive patients were included in a retrospective study if presenting with <350 CD4/uL and starting an antiretroviral treatment within 3 months of the diagnosis. Primary endpoint was 5-year survival according to the presence of CMV viremia (CMV-V), CMV end-organ disease (CMV-EOD) and anti-CMV treatment...
January 26, 2018: Antiviral Therapy
Amélie Duréault, Catherine Chapelon, Lucie Biard, Fanny Domont, Léa Savey, Bahram Bodaghi, Valérie Pourcher, Matthieu Resche Rigon, Patrice Cacoub, David Saadoun
Sarcoidosis is associated with cell-mediated immunodeficiency and treatment of symptomatic sarcoidosis usually includes systemic immunosuppressants. Data relative to incidence, prognosis factors, and outcome of infections are scarce.Retrospective cohort study of 585 patients with biopsy proven sarcoidosis in a tertiary referral specialist clinic, with a nested case-control analysis. Twenty nine patients (4.9%) with severe infections were compared to 116 controls subjects with sarcoidosis, matched according to their gender, ethnicity, age at diagnosis, and treatment with corticosteroids...
December 2017: Medicine (Baltimore)
Georgia McCaughan, Jennifer Massey, Ian Sutton, Jennifer Curnow
Alemtuzumab is a highly efficacious therapy used in the treatment of multiple sclerosis (MS), but uncoupling of T and B cell repopulation during immune reconstitution associates with an increasing range of secondary B cell-mediated autoimmune complications. A 34-year-old woman developed Graves' disease 11 months following an initial course of alemtuzumab treatment for MS. Nine months following the second treatment with alemtuzumab, the patient presented with spontaneous intramuscular and subcutaneous haemorrhage due to development of an inhibitory autoantibody to coagulation factor VIII...
December 5, 2017: BMJ Case Reports
Ema Kantorová, Michal Bittšanský, Štefan Sivák, Eva Baranovičová, Petra Hnilicová, Vladimír Nosáľ, Daniel Čierny, Kamil Zeleňák, Wolfgang Brück, Egon Kurča
BACKGROUND: Co-occurrence of multiple sclerosis (MS) and glial tumours (GT) is uncommon although occasionally reported in medical literature. Interpreting the overlapping radiologic and clinical characteristics of glial tumours, MS lesions, and progressive multifocal leukoencephalopathy (PML) can be a significant diagnostic challenge. CASE PRESENTATION: We report a case of anaplastic astrocytoma mimicking PML in a 27-year-old patient with a 15-year history of MS...
June 19, 2017: BMC Cancer
Andreas Kronbichler, Martin Windpessl, Herwig Pieringer, David R W Jayne
Rituximab (RTX), a chimeric, monoclonal anti-CD20 antibody, is increasingly used in immune-mediated renal diseases. While licensed in the induction treatment of ANCA-associated vasculitis, it represents one of the most commonly prescribed off-label drugs. Much of the information regarding its safety has been drawn from experience in hematology and rheumatology. Ample evidence illustrates the safety of RTX, however, rare but serious adverse events have emerged that include progressive multifocal leucoencephalopathy and hepatitis B reactivation...
June 2017: Autoimmunity Reviews
Mark S Igra, David Paling, Mike P Wattjes, Daniel J A Connolly, Nigel Hoggard
MRI has long been established as the most sensitive in vivo technique for detecting multiple sclerosis (MS) lesions. The 2010 revisions of the McDonald Criteria have simplified imaging criteria, such that a diagnosis of MS can be made on a single contrast-enhanced MRI scan in the appropriate clinical context. New disease-modifying therapies have proven effective in reducing relapse rate and severity. Several of these therapies, most particularly natalizumab, but also dimethyl fumarate and fingolimod, have been associated with progressive multifocal leukoencephalopathy (PML)...
June 2017: British Journal of Radiology
Kim Dao, Haithem Chtioui, Laura E Rothuizen, Léonore Diezi, Sylvain Prod'hom, Ursula Winterfeld, Thierry Buclin, Françoise Livio
The main pharmacovigilance updates in 2015are reviewed. Sofosbuvir amiodarone interaction: risk of severe bradycardia. Dasabuvir clopidogrel interaction: increased dasabuvir concentrations and potential risk of QTprolongation. SGLT2 inhibitors: risks of diabetic acidocetosis and bone fracture. Dabigatran: therapeutic drug monitoring may improve benefit-risk ratio. Ibuprofen: at higher dosage, vascular risks are comparable to coxibs. Pregabaline, gabapentine: potential for abuse and addiction. Varenicline: potentiates alcohol's effects...
January 13, 2016: Revue Médicale Suisse
S Sainz-de-la-Maza, J L Casado, M J Pérez-Elías, A Moreno, C Quereda, S Moreno, I Corral
BACKGROUND AND PURPOSE: Progressive multifocal leucoencephalopathy-associated immune reconstitution inflammatory syndrome (PML-IRIS) is the paradoxical worsening or unmasking of preexisting infection with JC virus attributable to a rapid recovery of the immune system after highly active antiretroviral therapy (HAART) initiation. We investigated the incidence and factors associated with PML-IRIS in HIV-infected patients. We also studied its influence on mortality of PML and the effect of corticosteroid therapy...
May 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Jean-Frédéric Colombel, Bruce E Sands, Paul Rutgeerts, William Sandborn, Silvio Danese, Geert D'Haens, Remo Panaccione, Edward V Loftus, Serap Sankoh, Irving Fox, Asit Parikh, Catherine Milch, Brihad Abhyankar, Brian G Feagan
OBJECTIVE: Vedolizumab is a gut-selective antibody to α4 β7 integrin for the treatment of ulcerative colitis (UC) and Crohn's disease (CD). We report an integrated summary of the safety of vedolizumab. DESIGN: Safety data (May 2009-June 2013) from six trials of vedolizumab were integrated. Adverse events were evaluated in patients who received ≥1 dose of vedolizumab or placebo and were reported as exposure-adjusted incidence rates as the number of patients experiencing the event per 100 person-years (PYs) of exposure...
May 2017: Gut
José Tomás, Maria Carmo Macário, Elsa Gaspar, Isabel Santana
Neurological complications of H1N1 infections are mostly found in children, but rare cases of acute encephalopathy and post-infectious encephalitis such as acute disseminated encephalomyelitis (ADEM) have been described in adults. We report a case of an adult presenting with a progressive and severe encephalopathy that developed after H1N1 respiratory infection resolution. Cerebrospinal fluid (CSF) analysis was normal, including negative PCR for herpes simplex virus, H1N1, influenza B and JC virus, and absent oligoclonal IgG bands in CSF and serum...
October 22, 2015: BMJ Case Reports
Md Yuzaiful Md Yusof, Edward M Vital, Maya H Buch
The development of B cell-targeted biologics represents a major advance in the treatment of autoimmune rheumatic diseases. As with other immunosuppressive agents, risk of infection is a key clinical concern. This review summarises safety data from 15 years of experience of rituximab in autoimmune diseases with a particular focus on opportunistic infection and class-specific complications and infection risk. Rarely, cases of progressive multifocal leucoencephalopathy in rituximab-treated patients (5/100 000) have accumulated over time although no proven causal association has yet been shown...
October 2015: Current Rheumatology Reports
Ana P Sousa, Paulo Santos, Claudia Fernandes, Rui Pedrosa
No abstract text is available yet for this article.
June 2015: Arquivos de Neuro-psiquiatria
Sarah Campbell, Avinash Kumar Kanodia, Jonathan O'Riordan
No abstract text is available yet for this article.
April 15, 2015: BMJ Case Reports
R E Ferner
Adverse drug reactions (ADRs) - that is, unintended and harmful responses to medicines - are important to dermatologists because many present with cutaneous signs and because dermatological treatments can cause serious ADRs. The detection of ADRs to new drugs is often delayed because they have a long latency or are rare or unexpected. This means that ADRs to newer agents emerge only slowly after marketing. ADRs are part of the differential diagnosis of unusual rashes. A good drug history that includes details of drug dose, time-course of the reaction and factors that may make the patient more susceptible, will help...
March 2015: Clinical and Experimental Dermatology
Mária Karácsony, Krisztina Bencsik, László Vécsei
Multiple sclerosis (MS) is the most common chronic disease of the central nervous system in young adults. No curative therapy is known. Currently, six drugs are available that can reduce the activity of MS. The first-line drugs can completely reduce the activity of the disease in nearly two-thirds of the patients. In the remainder, who suffer from breakthrough disease, the condition of the patient worsens, and second-line therapies must be used. The second-line drug natalizumab exhibits almost double efficacy of the first-line drugs, but also have less favourable adverse effects...
July 30, 2014: Ideggyógyászati Szemle
Fatima Dhalla, Sarah Murray, Ross Sadler, Benjamin Chaigne-Delalande, Tomohiko Sadaoka, Elizabeth Soilleux, Gulbu Uzel, Joanne Miller, Graham Peter Collins, Christian Simon Ross Hatton, Malini Bhole, Berne Ferry, Helen M Chapel, Jeffrey I Cohen, Smita Y Patel
XMEN disease (X-linked immunodeficiency with Magnesium defect, Epstein-Barr virus infection and Neoplasia) is a novel primary immune deficiency caused by mutations in MAGT1 and characterised by chronic infection with Epstein-Barr virus (EBV), EBV-driven lymphoma, CD4 T-cell lymphopenia, and dysgammaglobulinemia [1]. Functional studies have demonstrated roles for magnesium as a second messenger in T-cell receptor signalling [1], and for NKG2D expression and consequently NK- and CD8 T-cell cytotoxicity [2]. 7 patients have been described in the literature; the oldest died at 45 years and was diagnosed posthumously [1-3]...
February 2015: Journal of Clinical Immunology
Anna Jamroz-Wiśniewska, Jacek Jaworski, Dorota Suszek, Marzena Janczarek, Zbigniew Stelmasiak, Konrad Rejdak, Halina Bartosik-Psujek
We present a case of a 30-year-old Polish female who presented with increasing for about 2 years spastic paraparesis and urinary incontinence. She denied any risky sexual behaviors, drug abuse, there was no history of surgery or blood transfusions. MRI of the brain showed diffuse, hyperintensive in T2, poorly defined lesions in the white matter. About 3 months later paraparesis increased and control MRI showed progression of previously described lesions. She was then diagnosed with HIV infection. There was a suspicion of progressive multifocal leucoencephalopathy (PML) or vacuolar myelopathy in the course of HIV infection...
2014: Neurologia i Neurochirurgia Polska
Maria-Eleptheria Evangelopoulos, Vasilios Koutoulidis, Kostas Kilidireas, Dimitrios-Stergios Evangelopoulos, Georgios Nakas, Elisabeth Andreadou, Lia-Angela Moulopoulos
Natalizumab (NTM) represents an effective drug for the treatment of relapsing-remitting multiple sclerosis (RRMS). Progressive multifocal leucoencephalopathy (PML) is a potential life-threatening complication of NTM treatment. A close follow-up and MRI monitoring of patients under NTM are required to avoid such devastating complications. The case of a 47-year-old woman with RRMS (EDSS 1.5) treated with NTM for 44 months is reported. The patient had a relapse with mild cerebellar symptomatology and visual complaints...
January 2015: Journal of Clinical Medicine Research
R Alroughani, A Almulla, S Lamdhade, A Thussu
Although few recent studies have reported efficacy and safety data among patients with multiple sclerosis (MS) switching between immunotherapies, data on the mechanism of rebound activity postwithdrawal of fingolimod in patients with MS is scarce. A 36-year-old woman developed severe reactivation of her disease within 7 weeks of fingolimod's withdrawal despite the absence of breakthrough disease during the 8-week natalizumab washout period previously. The clinical presentation and radiological features were described indicating the diagnostic challenge given the potential risk of developing progressive multifocal leucoencephalopathy...
2014: BMJ Case Reports
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