0 rating

Infectious Complications

Progressive neurologic dysfunction in a psoriasis patient treated with dimethyl fumarate.

Bartsch T, Rempe T, Wrede A et al.

University Hospital of Schleswig-Holstein, Kiel, Germany.

 Ann Neurol 2015;78:501–14.

Stefan Bittner’s review: Bartsch and colleagues report on a patient with psoriasis who developed progressive multifocal leukoencephalopathy (PML) during treatment with dimethyl fumarate (DMF). The patient had slowly progressing clinical deficits starting with facial dysesthesia and evolving into left hemisensory dysfunction, predominantly left-sided tetraparesis, ataxia, brainstem signs, and focal motor seizures over a period of 2 years. Serial magnetic resonance images paralleled the clinical disease course, revealing a slowly enlarging T2 hyperintense lesion within the right thalamus that expanded into the internal capsule, the brainstem, and the frontoparietal lobes. Extensive laboratory and radiological testing did not reveal any conclusive findings and a JC virus (JCV) polymerase chain reaction using a cerebrospinal fluid sample was negative. Finally, a brain biopsy led to the diagnosis of PML. Fumarates were then ceased and treatment with mirtazapine and mefloquine was initiated. The clinical and radiological disease course stabilized after 4 months of this treatment. This case is informative and instructive for daily clinical practice as well as for future research efforts.

Return to top

RELATED ARTICLES

The Role of B Cells in Multiple Sclerosis: Experimental and Clinical Aspects
Til Menge, MD, Gerd Meyer zu Hörste, MD, and Bernd C Kieseier, MD
CML Multiple Sclerosis
Pharmacogenomics in Multiple Sclerosis
Manuel Comabella, MD and Xavier Montalban, MD
CML Multiple Sclerosis
The Role of MRI as a Predictive Marker for Disease Progression Measured by the Expanded Disability Status Scale
Antonia Ceccarelli, MD, Domenico Caputo, MD, and Marco Rovaris, MD
CML Multiple Sclerosis
Advances in Multiple Sclerosis Therapy: New Oral Disease-Modifying Agents
Andreas Lutterotti, MD and Thomas Berger, MD, MSc
CML Multiple Sclerosis
Optical Coherence Tomography as a Marker of Axonal Damage in Multiple Sclerosis
Shiv Saidha, MRCPI, Christopher Eckstein, MD, and John N Ratchford, MD
CML Multiple Sclerosis

LATEST ARTICLES