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Letter
Transient gadolinium leakage in natalizumab-treated multiple sclerosis
  1. Sven Haller1,
  2. Frederik Barkhof2,
  3. Mike P Wattjes2,
  4. Patrice H Lalive3,4
  1. 1 Department of Imaging and Medical Informatics, University Hospitals of Geneva and Faculty of Medicine of the University of Geneva, Geneva, Switzerland
  2. 2 Department of Radiology & Nuclear Medicine and PET Research, VU University Medical Centre, Amsterdam, The Netherlands
  3. 3 Department of Clinical Neurosciences, Division of Neurology, Unit of Neuroimmunology and Multiple Sclerosis, Geneva University Hospital and Faculty of Medicine of the University of Geneva, Geneva, Switzerland
  4. 4 Department of Genetic and Laboratory Medicine, Division of Laboratory Medicine, Geneva University Hospital, Geneva, Switzerland
  1. Correspondence to Dr Sven Haller, Service neuro-diagnostique et neuro-interventionnel DISIM, University Hospitals of Geneva, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland; sven.haller{at}hcuge.ch

https://doi.org/10.1136/jnnp-2014-309069

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    Introduction

    Natalizumab (NTZ; Biogen Idec, Cambridge, Massachusetts, USA) is a recombinant humanised immunoglobulin G4 monoclonal antibody approved for the treatment of relapsing-remitting multiple sclerosis (RRMS).1 It selectively inhibits the adhesion α4-β1 receptor on the surface of lymphocytes, monocytes, basophils and eosinophils preventing the interaction of immune cells with the integrin vascular cell adhesion molecule-1 (VCAM-1) on endothelial cells and with structures of the extracellular matrix and hindering cells from leaving the vascular compartment of the brain.2 This mainly hinders circulating cells from leaving the vascular compartment but may also have other consequences on signalling and apoptosis.3

    We report the case of a patient with NTZ-treated RRMS who developed a new type of atypical lesion on MRI, consisting of a transient and ill-defined gadolinium enhancement without a typically associated T2 or fluid-attenuated inversion recovery (FLAIR) lesion.

    Patient

    A patient was diagnosed with RRMS in 2004 with, on average, one relapse per 18 months. Treatment was switched from interferon-β1a (IFNβ-1a) 44 µg three times weekly to NTZ. Follow-up imaging was performed 1 year after treatment modification and demonstrated the appearance of two atypical contrast-enhancing lesions. The first lesion appeared in the right temporal white matter adjacent to the ventricular system with a …

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    Footnotes

    • Contributors SH and PHL were involved in the development of study concept and design, acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content, and study supervision. FB contributed in the analysis and interpretation, and critical revision of the manuscript for important intellectual content. MPW performed the analysis and interpretation, and critical revision of the manuscript for important intellectual content.

    • Competing interests SH is the section editor Neuroradiology, editorial board member Journal of Alzheimer’s Disease and American Journal of Neurodegenerative Disease, principal investigator Swiss National Science Foundation SNF project 320030_147126/1 and VELUX Foundation project 608, co-investigator SNF project 33CM30_140334/1. FB is the editorial board member Brain, Eur Radiology, Neuroradiology, Multiple Sclerosis Journal, Radiology and Neurology; and Consultant for Bayer-Schering Pharma, Sanofi-Aventis, Biogen-Idec, TEVA, Merck-Serono, Novartis, Roche, Synthon BV, Jansen Research and Genzyme; has received Grants Dutch MS Society, EU-FP7. Also, FB has received payment for the development of educational presentations including service on speakers’ bureaus Serono Symposia Foundation, MedScape. MPW is the member of editorial board European Radiology; and Consultant for Biogen Idec. PHL is the principal investigator Swiss National Science Foundation SNF project 310030_153164, and has received grant from the Swiss multiple sclerosis society. PHL has received honoraria for speaking from Biogen-Idec, Merck Serono, Novartis, Sanofi-Aventis and Teva; and consulting fees from Biogen-Idec, Geneuro, Genzyme, Merck Serono, Novartis, Sanofi-Aventis and Teva; and research grants from Biogen-Idec, Merck Serono, Novartis.

    • Patient consent Obtained.

    • Ethics approval Ethical committee University Hospital Geneva.

    • Provenance and peer review Not commissioned; externally peer reviewed.