Premium
Progressive neurologic dysfunction in a psoriasis patient treated with dimethyl fumarate
Author(s) -
Bartsch Thorsten,
Rempe Torge,
Wrede Arne,
Leypoldt Frank,
Brück Wolfgang,
Adams Ortwin,
Rohr Axel,
Jansen Olav,
Wüthrich Christian,
Deuschl Günther,
Koralnik Igor J.
Publication year - 2015
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.24471
Subject(s) - dimethyl fumarate , lymphocytopenia , progressive multifocal leukoencephalopathy , medicine , psoriasis , brain biopsy , multiple sclerosis , jc virus , pathology , cerebrospinal fluid , leukopenia , leukoencephalopathy , natalizumab , dermatology , biopsy , immunology , lymphocyte , chemotherapy , disease
Progressive multifocal leukoencephalopathy (PML) has recently been described in psoriasis or multiple sclerosis patients treated with fumaric acid esters (fumarates), who had developed severe and long‐standing lymphocytopenia (<500/mm 3 ). We report a psoriasis patient who presented with progressive neurologic dysfunction and seizures after 2.5 years of fumarate therapy. Despite absolute lymphocyte counts remaining between 500‐1000/mm 3 , his CD4 + and CD8 + T‐cell counts were markedly low. MRI showed right hemispheric and brainstem lesions and JC virus DNA was undetectable in his cerebrospinal fluid. Brain biopsy revealed typical features of PML as well as JC virus‐infected neurons. Clinicians should consider PML in the differential diagnosis of fumarate‐treated patients presenting with brain lesions or seizures even in the absence of severe lymphocytopenia. ANN NEUROL 2015;78:501–514