Efficacy of Natalizumab in Intermediate Uveitis Related to Multiple Sclerosis: A Case Report

Background

Tumefactive demyelinating lesions (TDL) usually correspond to solitary lesions greater than 2 cm, mimicking neoplasms in multiple sclerosis (MS). They are a rare presentation of MS and their prevalence is estimated to be 1 – 3/1000 cases with an incidence of 0.3/100 000 per year. Differentiating the diagnosis from primary brain neoplasms, like lymphoma or high-grade gliomas, remains challenging. Specific MRI features such as incomplete rim enhancement, high apparent diffusion coefficient values, and a large number of lesions can help the clinician. So far, corticosteroids and plasma exchange are the standard treatment. Introduction of immunosuppressive therapies clearly modified the course of relapsing-remitting MS but is still controversial in TDL [1]. The pathophysiological association between uveitis and MS has not yet been shown. Thus, specific treatment for this condition is not well defined.

Natalizumab (Tysabri^®) is a humanized IgG4 monoclonal antibody directed against the α4 chain of integrins. It was previously used in the treatment of inflammatory bowel disease and was one of the first targeted therapies approved for relapsing forms of MS [2], [3]. But natalizumab therapy is also associated with an increased incidence of progressive leukoencephalitis. A stratification of the risk can be assessed by the anti-JC virus antibody index.

Prevalence of uveitis among MS patients varies greatly according to previous epidemiologic studies, but is approximatively 0.65 to 1.1% in large series [4]. Herein, we report an intermediate uveitis related to TDL, with a favorable evolution under natalizumab treatment, after a 1-year follow-up.

• References

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