Abstract
In this case report we describe the first non-fatal herpes simplex virus encephalitis (HSE) case with natalizumab for multiple sclerosis (MS). A 36-year-old woman, previously treated with immunomodulatory and immunosuppressive drugs for MS, developed acute encephalitis after 6 monthly natalizumab perfusions. Brain imaging demonstrated suggestive bi-temporal lesions. Herpes simplex virus type-1 DNA was detected in cerebrospinal fluid. The patient improved gradually after a 21-day course of intravenous acyclovir, but neuropsychiatric changes remained 5 months later. Our non-fatal case of HSE and other reported cases of herpes infections provide evidence of an increased risk with natalizumab and point to the need for clinicians to maintain awareness.
MeSH terms
-
Acyclovir / administration & dosage
-
Adult
-
Antibodies, Monoclonal, Humanized / administration & dosage
-
Antibodies, Monoclonal, Humanized / adverse effects*
-
Antiviral Agents / administration & dosage
-
Cognition / drug effects
-
DNA, Viral / cerebrospinal fluid
-
Drug Administration Schedule
-
Encephalitis, Herpes Simplex / chemically induced*
-
Encephalitis, Herpes Simplex / diagnosis
-
Encephalitis, Herpes Simplex / drug therapy*
-
Encephalitis, Herpes Simplex / psychology
-
Encephalitis, Herpes Simplex / virology
-
Female
-
Herpesvirus 1, Human / drug effects*
-
Herpesvirus 1, Human / genetics
-
Herpesvirus 1, Human / pathogenicity
-
Humans
-
Immunologic Factors / administration & dosage
-
Immunologic Factors / adverse effects*
-
Infusions, Intravenous
-
Magnetic Resonance Imaging
-
Memory / drug effects
-
Multiple Sclerosis, Relapsing-Remitting / drug therapy*
-
Natalizumab
-
Time Factors
-
Treatment Outcome
-
Virus Activation / drug effects
Substances
-
Antibodies, Monoclonal, Humanized
-
Antiviral Agents
-
DNA, Viral
-
Immunologic Factors
-
Natalizumab
-
Acyclovir