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Contrast-Enhancing Lesions within the Spinal Chord Suggests Immune Reconstitution Inflammatory Syndrome (IRIS) in a Patient with Natalizumab Associated Progressive Multifocal Leukencephalopathy (Natalizumab-PML)

Justus Carl Marquetand, Felix Bischof and Thomas Nägele

Background: Many patients with natalizumab-associated progressive multifocal leukoencephalopathy (PML) who are treated by plasma exchange (PLEX) develop an immune reconstitution inflammatory syndrome (IRIS), which often leads to severe tissue destruction within the brain. While steroids can efficiently treat IRIS, they worsen PML and a reliable and prompt diagnosis of IRIS in natalizumab-PML patients is thus critical.

Clinical presentation: We report on a patient with supratentorial manifestations of natalizumab-PML after PLEX and corresponding new gadolinium-enhancing lesions within the spinal cord, which were clinically corresponding to difficulties to urinate.

Conclusion: Cerebral MRI supported the diagnosis of IRIS. Therefore, detection of contrast-enhancing lesions within the spinal cord may indicate IRIS in patients with natalizumab-PML.