Indiana University Infectious Diseases Fellowship
26 Feb,
11 tweets, 5 min read
#idboardreview 40 F multiple sclerosis on natalizumab presents w/ coordination difficulties and cognitive impairment. MRI non-enhancing subcortical white matter frontal lesions hyperintense on T2 & hypointense on T1. Diagnosis? #medEd #idmedEd #IDtwitter 
#progressive multifocal leukoencephalopathy (PML) increase risk with #natalizumab
#PML Ref P&P ID Mandell
#PML is a rare but often lethal and untreatable disorder of CNS with large white-matter lesions typically occurring in immunocompromised patients: HIV & impaired cellular immunity from other causes, anti–α4-integrin tx w/ natalizumab
#PmL pathogenesis primary infection w/ JC virus is asymptomatic & becomes latent. 39% healthy ppl have +pcr in tonsillar tissue. +pcr in urine so kidney also site of latency. Also detected in bone marrow & brain.
#JCV infects oligodendrocytes & astrocytes in brain & rarely spinal cord: lyric lesion that destroys mylein sheath
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