Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2014 Jan 30:11:19.
doi: 10.1186/1742-2094-11-19.

Varicella zoster-associated retinal and central nervous system vasculitis in a patient with multiple sclerosis treated with natalizumab

Xenia Kobeleva, Florian Wegner, Inez Brunotte, Mete Dadak, Reinhard Dengler, Martin Stangel  1
Affiliations
Case Reports

Varicella zoster-associated retinal and central nervous system vasculitis in a patient with multiple sclerosis treated with natalizumab

Xenia Kobeleva et al. J Neuroinflammation. .

Abstract

We report the first case of combined retinal and CNS varicella zoster-associated vasculitis in a 49-year-old patient with multiple sclerosis who had been treated with natalizumab. He presented with a progressive bilateral visual loss. The diagnosis of a vasculitis was based on the fundoscopic examination and MRI findings. We confirmed the varicella zoster virus (VZV) infection of the CNS by PCR and increased intrathecal antibody indices in the cerebrospinal fluid. The patient was stabilized with antiviral treatment, methylprednisolone, plasmapheresis and cycophosphamide. Natalizumab was discontinued. This case illustrates the neuroimmunological and neuroinfectiological consequences of treatments with biologicals that influence the immune system.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Fundoscopic examination at the beginning and after treatment. The initial fundoscopic examination of the right eye (A) shows a peripheral necrotizing retinitis and periarteritis (arrow). The follow-up examination after treatment (B) of the left eye presents an extensive posterior retinal necrosis (pentangle) and pigmentary changes of affected areas (arrow).
Figure 2
Figure 2
Brain magnetic resonance imaging (MRI) at the initial presentation and after two months. Brain MRI five days after admission (A-D) shows a FLAIR-weighted image with non-active MS typical lesions (B), a diffusion-weighted image illustrating multiple dot-shaped cortical and subcortical lesions with restricted diffusion not limited to a large-vessel vascular territory and corresponding reduction on the apparent diffusion coefficient sequence (B,C), a contrast enhanced T1-weighted image without any intracerebral contrast enhancement (D; circular contrast uptake of the cerebral meninges due to a previous lumbar puncture). The follow-up MRI after two months (E-F) shows a diffusion-weighted image without any new lesions (E) and a contrast enhanced T1-weighted image with dot-shaped contrast-enhancing lesions (F) in contrast to the initial presentation.
See this image and copyright information in PMC

References

    1. Yednock TA, Cannon C, Fritz LC, Sanchez-Madrid F, Steinman L, Karin N. Prevention of experimental autoimmune encephalomyelitis by antibodies against alpha 4 beta 1 integrin. Nature. 1992;356:63–66. doi: 10.1038/356063a0. - DOI - PubMed
    1. Chan PY, Aruffo A. VLA-4 integrin mediates lymphocyte migration on the inducible endothelial cell ligand VCAM-1 and the extracellular matrix ligand fibronectin. J Biol Chem. 1993;268:24655–24664. - PubMed
    1. Polman CH, O’Connor PW, Havrdova E, Hutchinson M, Kappos L, Miller DH. et al.A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med. 2006;354:899–910. doi: 10.1056/NEJMoa044397. - DOI - PubMed
    1. Rudick RA, Stuart WH, Calabresi PA, Confavreux C, Galetta SL, Radue EW. et al.Natalizumab plus interferon beta-1a for relapsing multiple sclerosis. N Engl J Med. 2006;354:911–923. doi: 10.1056/NEJMoa044396. - DOI - PubMed
    1. Bloomgren G, Richman S, Hotermans C, Subramanyam M, Goelz S, Natarajan A. et al.Risk of natalizumab-associated progressive multifocal leukoencephalopathy. N Engl J Med. 2012;366:1870–1880. doi: 10.1056/NEJMoa1107829. - DOI - PubMed

Publication types

Substances