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Abstract Details

Cryptococcal Meningitis and Immune Reconstitution Inflammatory Syndrome (IRIS) in a Multiple Sclerosis Patient Taking Natalizumab
MS and Related Diseases
P01 - (-)
179
BACKGROUND: Natalizumab was approved in the US in 2004 for treatment of MS, however it was withdrawn from the market after its use was associated with progressive multifocal leukoencephalopathy (PML). Natalizumab returned to the US market in 2006 as treatment for relapsing remitting MS (RR-MS). Other reported adverse events include melanoma, primary central nervous system lymphoma, gastrointestinal cryptosporidiosis and IRIS in the setting of PML. In our extensive literature search, we found no reported case of cryptococcal meningitis and IRIS in MS patients treated with natalizumab.
DESIGN/METHODS: This is a case report of cryptococcal meningitis and IRIS developing in a MS patient treated with natalizumab.
RESULTS: A 49-year old Caucasian male with RR-MS developed cryptococcal meningitis while taking natalizumab, followed by IRIS 2 months after natalizumab discontinuation. Cerebrospinal fluid anti-JC virus polymerase chain reaction and human immunodeficiency virus serology were repeatedly negative. We believe this is the first reported case of cryptococcal meningitis and IRIS after natalizumab therapy.
CONCLUSIONS: Natalizumab is often used in MS patients who have had an inadequate response to or are unable to tolerate an alternate MS therapy. However, natalizumab use has been associated with potentially fatal complications like PML. As of March 2012, approximately 99,600 patients have received natalizumab with 242 confirmed cases of PML worldwide. Data on the phase III clinical trial on natalizumab safety and efficacy in RR-MS yielded no information about cryptococcal meningitis as an adverse event of treatment. Although information is lacking regarding recommendations for treating natalizumab-associated cryptococcal meningitis, discontinuation of therapy along with anti-fungal treatment with steroids for post-discontinuation IRIS is one potential approach.
Authors/Disclosures
Reuben M. Valenzuela, MD (HSHs St. John's Multiple sclerosis center)
PRESENTER 		No disclosure on file
John Pula, MD, FAAN (NorthShore University HealthSystem) Dr. Pula has nothing to disclose.
Dennis J. Garwacki, MD No disclosure on file
Jorge C. Kattah, MD, FAAN (University of Illinois College of Medicine at Peoria) Dr. Kattah has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Bonezzi, Switzer , Poilitto and Hupp Legal Firm.
Amy Colcher, MD (Cooper Neurological Institute) No disclosure on file
Hans-Peter Hartung, MD, FAAN (Heinrich Heine University Medical Faculty) Dr. Hartung has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS Celgene. Dr. Hartung has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Geneuro. Dr. Hartung has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Hartung has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Hartung has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Hartung has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer. Dr. Hartung has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Hartung has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Hartung has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers Neurology.