Possible progressive multifocal leukoencephalopathy and active multiple sclerosis under dimethyl fumarate: the central role of MRI in informing therapeutic decisions
Elena Augusta Vola,
Maria Petracca,
Sirio Cocozza,
Marcello De Angelis,
Antonio Carotenuto,
Giuseppe Pontillo,
Vincenzo Brescia Morra,
Enrico Tedeschi,
Roberta Lanzillo
Affiliations
Elena Augusta Vola
Department of Advanced Biomedical Sciences, “Federico II” University
Maria Petracca
Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University
Sirio Cocozza
Department of Advanced Biomedical Sciences, “Federico II” University
Marcello De Angelis
Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University
Antonio Carotenuto
Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University
Giuseppe Pontillo
Department of Advanced Biomedical Sciences, “Federico II” University
Vincenzo Brescia Morra
Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University
Enrico Tedeschi
Department of Advanced Biomedical Sciences, “Federico II” University
Roberta Lanzillo
Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University
Abstract Background Progressive multifocal leukoencephalopathy (PML) can rarely occur in Multiple Sclerosis (MS) patients undergoing dimethyl fumarate (DMF) treatment. Our case stresses the limits of current diagnostic and stratification risk criteria, highlighting the potential role of Magnetic Resonance Imaging (MRI) in advising clinical choices. Case presentation A 54 years old MS male patient treated with DMF, after 3 years of clinical stability developed a subacute clinical worsening. He had no severe lymphopenia but MRI signs suggestive of a coexistence of PML and MS activity. Although his viral title was negative, DMF was discontinued, with clinical and radiological improvement. Conclusions This case highlights the challenges behind PML diagnosis, especially in patients not fulfilling the risk stratification criteria and that might present with concurrent disease activity, stressing the potential role of MRI in informing therapeutic decisions.
