Natalizumab is currently one of the best options for treatment of patients with Multiple Sclerosis who have failed traditional prior therapies. However, prolonged use, prior immunosuppressive therapy and anti-JCV antibody status have been associated with increased risk of developing progressive multifocal leukoencephalopathy (PML). The evaluation of these conditions has been used to estimate risks of PML in these patients, and distinct (sometimes extreme) approaches are used to avoid the PML onset. At this time, the biggest issue facing the use of Natalizumab is how to get a balance between the risks and the benefits of the treatment. Hence, strategies for monitor JCV-positive patients undergoing Natalizumab treatment are deeply necessary. To illustrate it, we monitored JCV/DNA in blood and urine of a patient receiving Natalizumab for 12 months. We also bring to discussion the effectiveness of the current methods used for risk evaluation, and the real implications of viral reactivation.Keywords: multiple sclerosis, Natalizumab, JCV, risk factors, progressive multifocal leucoencephalopaty, viruria. RESUMO Natalizumabe Ă© atualmente uma das melhores opçÔes para o tratamento de pacientes com Esclerose MĂșltipla que nĂŁo respondem aos tratamentos tradicionais. No entanto, o seu uso prolongado, o uso de terapia imunossupressora prĂ©via e o status sorolĂłgico antivĂrus JC tĂȘm sido associados com o risco aumentado de desenvolvimento de Leucoencefalopatia Multifocal Progressiva (LEMP). A avaliação destas condiçÔes tem sido utilizada para estimar os riscos do desenvolvimento de LEMP nestes pacientes, e abordagens distintas (por vezes extremas) sĂŁo empregadas para evitar o aparecimento dessa patologia. Atualmente, o grande desafio estĂĄ em obter um equilĂbrio entre os riscos e os benefĂcios do tratamento com Natalizumabe. Assim, Ă© crucial desenvolver estratĂ©gias para monitorar pacientes portadores do vĂrus JC sob tratamento com Natalizumabe. A tĂtulo de ilustração, pesquisamos o vĂrus no sangue e na urina de um paciente sob tratamento durante 12 meses. TambĂ©m discutimos a eficĂĄcia dos mĂ©todos atualmente utilizados para avaliação de riscos e as implicaçÔes reais de reativação viral.Palavras-chave: esclerose mĂșltipla, Natalizumabe, vĂrus JC, leucoencefalopatia multifocal progressiva, viruria. Natalizumab (Tysabri), used for treatment of relapsingremitting multiple sclerosis (MS), is a monoclonal antibody directed to the a4b1 integrin, a subunit of an adhesion molecule expressed on the surface of T lymphocytes. The antibodies act by blocking the migration of T Lymphocytes from blood to the CNS through the blood brain barrier (BBB) and attenuate the inflammatory effects 1 . The AFFIRM study showed that monotherapy with Natalizumab (NTZ) for 2 years decreased the relapse rate by 68% and the disability progression rate by 42% compared with placebo 2 . NTZ is well tolerated and the overall incidence of serious adverse events is low. Although the efficacy of NTZ is up to