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Natalizumab is an effective treatment in patients with highly active relapsing-remitting multiple sclerosis (RRMS). However, its positive therapeutic effects have to be weighed against the potential serious adverse event of progressive multifocal leukoencephalopathy (PML). Thus, whenever patients with MS on natalizumab develop uncommon and progressive neurologic symptoms, the suspicion of PML has to be raised. The risk of PML becomes higher with increasing duration of natalizumab treatment, prior immunosuppressive treatment, and JC virus (JCV) antibody seropositivity.1 We here report a case of MS in which unusual symptoms in the context of 5 years of natalizumab treatment and seroconversion to JCV antibody positivity led to the initial suspicion of PML and a final diagnosis of Creutzfeldt-Jakob disease (CJD).

Unusual deterioration in a patient with multiple sclerosis on natalizumab therapy