Abstract
We report a 76-year-old MS patient, treated with DMF for 3 years. Lymphocytes never showed values below 1240/µl. CSF analysis revealed 1,988,880 copies/ml of JCV-DNA, JCV-DNA was detectable in serum and anti-JCV-antibody in CSF and serum were highly positive. Stratify®-JCV-test was positive. CD8-positive T-lymphocytes were reduced. Therapy with mefloquine, mirtazapine and cidofovir resulted in complete elimination of the virus in serum and 90% reduction of viral load in CSF. This case shows that despite careful monitoring for lymphopenia JCV spreading to the CSF may occur during treatment with DMF.
Keywords:
Dimethylfumarate; Multiple sclerosis; PML; Progressive multifocal leukoencephalopathy.
MeSH terms
-
Aged
-
Antibodies, Viral / blood
-
Antibodies, Viral / cerebrospinal fluid
-
DNA, Viral / blood
-
DNA, Viral / cerebrospinal fluid
-
Dimethyl Fumarate / therapeutic use*
-
Female
-
Humans
-
Immunosuppressive Agents / therapeutic use*
-
JC Virus* / genetics
-
JC Virus* / immunology
-
Multiple Sclerosis, Relapsing-Remitting / complications
-
Multiple Sclerosis, Relapsing-Remitting / drug therapy*
-
Multiple Sclerosis, Relapsing-Remitting / immunology*
-
Polyomavirus Infections / complications
-
Polyomavirus Infections / drug therapy
-
Polyomavirus Infections / immunology
-
Tumor Virus Infections / complications
-
Tumor Virus Infections / drug therapy
-
Tumor Virus Infections / immunology
Substances
-
Antibodies, Viral
-
DNA, Viral
-
Immunosuppressive Agents
-
Dimethyl Fumarate