Progressive neurologic dysfunction in a psoriasis patient treated with dimethyl fumarate

Thorsten Bartsch*, Torge Rempe, Arne Wrede, Frank Leypoldt, Wolfgang Brück, Ortwin Adams, Axel Rohr, Olav Jansen, Christian Wüthrich, Günther Deuschl, Igor J. Koralnik

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Progressive multifocal leukoencephalopathy (PML) has recently been described in psoriasis or multiple sclerosis patients treated with fumaric acid esters (fumarates), who had developed severe and long-standing lymphocytopenia (<500/mm3). 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.

Original languageEnglish (US)
Pages (from-to)501-514
Number of pages14
JournalAnnals of neurology
Issue number4
StatePublished - Oct 1 2015

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology


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