Progressive neurologic dysfunction in a psoriasis patient treated with dimethyl fumarate

We report a psoriasis patient who presented with progressive neurologic dysfunction and seizures after 2.5 years of fumarate therapy. Despite absolute lymphocyte counts remaining between 500‐1000/mm3, his CD4+ and CD8+ T‐cell counts were markedly low. MRI showed right hemispheric and brainstem lesions and JC virus DNA was undetectable in his cerebrospinal fluid. Brain biopsy revealed typical features of PML as well as JC virus‐infected neurons. Clinicians should consider PML in the differential diagnosis of fumarate‐treated patients presenting with brain lesions or seizures even in the absence of severe lymphocytopenia. ANN NEUROL 2015

Source: Annals of Neurology - July 31, 2015 Category: Neurology Authors: Thorsten Bartsch, Torge Rempe, Arne Wrede, Frank Leypoldt, Wolfgang Brück, Ortwin Adams, Axel Rohr, Olav Jansen, Christian Wüthrich, Günther Deuschl, Igor J. Koralnik Tags: Neurology Grand Rounds Source Type: research