• Viviana Lo Buono, Giangaetano D'Aleo, Simona Cammaroto, Maria Cristina De Cola, Francesca Palmese, Chiara Smorto, Silvia Marino, Giuseppe Venuti, Edoardo Sessa, Carmela Rifici, and Francesco Corallo.
• IRCCS Centro Neurolesi Bonino Pulejo, 98100 Messina, Italy.
• Medicina (Kaunas). 2022 Apr 17; 58 (4).

BackgroundProgressive multifocal leukoencephalopathy (PML) is a viral disease characterized by progressive damage or inflammation of the cerebral white matter that can be encountered in patients with multiple sclerosis (MS). There are cases of PML caused by pharmacological agents including natalizumab. Therefore, in patients treated with this drug, early identification of PML allows changes in the treatment plan, reducing the risks of morbidity and mortality.Case PresentationWe reported the case of a 57-year-old female diagnosed with relapsing-remitting MS, who presented with PML related to natalizumab. The patient presented with change in behavioral, radiological abnormalities in the left parieto-temporal lobes. We described the longitudinal course of PML, from the diagnosis until the patient's death, documenting the progressive deterioration of her cognitive functioning, supported by changes on sequential brain scans and neurophysiological data.ConclusionThe neuropsychological impairment documented in this case study expands the range of treatment-related complications associated with natalizumab, and provides evidence that occurrence of "atypical" cognitive deficits in MS may support the early diagnosis of PML.

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