Elevation of serum neurofilament light-chain levels disclose possible occult progressive multifocal leukoencephalopathy and immune reconstitution syndrome in a patient receiving ozanimod: a case report

We report the first case of findings suggestive of progressive multifocal leukoencephalopathy and immune restitution syndrome (PML-IRIS) in a patient with multiple sclerosis receiving ozanimod preceded by an unexpected increase in the serum neurofilament light-chain (sNfL) levels. A 57-year-old-woma...

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Bibliographic Details
Published in:Frontiers in immunology 2024-10, Vol.15, p.1465678
Main Authors: Quintanilla-Bordás, Carlos, Gorriz, David, Cubas-Núñez, Laura, Castillo-Villalba, Jéssica, Carreres-Polo, Joan, Casanova, Bonaventura, Pérez-Miralles, Francisco Carlos
Format: Article
Language:English
Subjects:
Biomarkers - blood
Female
Humans
immune reconstitution inflammatory syndrome (IRIS)
Immune Reconstitution Inflammatory Syndrome - blood
Immune Reconstitution Inflammatory Syndrome - diagnosis
Immune Reconstitution Inflammatory Syndrome - etiology
Immunology
Leukoencephalopathy, Progressive Multifocal - blood
Leukoencephalopathy, Progressive Multifocal - diagnosis
Leukoencephalopathy, Progressive Multifocal - etiology
Magnetic Resonance Imaging
Middle Aged
multiple sclerosis
Multiple Sclerosis - blood
Multiple Sclerosis - drug therapy
neurofilament light (NfL) chain
Neurofilament Proteins - blood
ozanimod (PubChem CID: 52938427)
progressive multifocal leukoencephalopathy (PML)
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Summary:We report the first case of findings suggestive of progressive multifocal leukoencephalopathy and immune restitution syndrome (PML-IRIS) in a patient with multiple sclerosis receiving ozanimod preceded by an unexpected increase in the serum neurofilament light-chain (sNfL) levels. A 57-year-old-woman treated with ozanimod for the last 8 years presented, during surveillance MRI, with findings compatible with PML-IRIS. Overt clinical symptoms were absent. sNfL levels increased 4 months earlier and peaked at presentation. Lymphocyte count reached nadir of 330/mL at 8 months earlier. The case illustrates the utility of sNfL levels for PML surveillance in patients receiving immunosuppressors.
ISSN:1664-3224
1664-3224
DOI:10.3389/fimmu.2024.1465678