Disseminated Enteroviral Infection Associated with Obinutuzumab

Dendle, Claire; Gilbertson, Michael; Korman, Tony M.; Golder, Vera; Morand, Eric Francis; Opat, Stephen

doi:10.3201/eid2109.150104

Cited by 21 publications

(19 citation statements)

References 12 publications

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“…In all these patients the time interval between treatment with Rituximab and neurological symptoms was variable (concurrent to 11 months after completion) and patients died from EV meningoencephalitis, another infection or had only partial neurological improvement. 6,11–18.…”

Section: Discussionmentioning

confidence: 99%

Enteroviral Encephalitis in a Child With CNS Relapse of Burkitt Leukemia Treated With Rituximab

Shaheen

Mussai

2019

Journal of Pediatric Hematology/Oncology

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A boy with central nervous system relapse of Burkitt leukemia developed fever and neurological symptoms and cognitive impairment. He had received multi-drug chemotherapy including rituximab. Enterovirus (EV) was detected in cerebrospinal fluid by polymerase chain reaction, and magnetic resonance imaging findings were consistent with viral infection. The patient was treated with intravenous immunoglobulin and within 1 month cleared his EV. Rituximab can cause a profound B-cell deficiency predisposing patients to infections including EV encephalitis. This is the first report of enteroviral encephalitis in a child undergoing treatment for lymphoma with rituximab and suggests the need to watch for this complication of therapy.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0/.

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Section: Discussionmentioning

confidence: 99%

Enteroviral Encephalitis in a Child With CNS Relapse of Burkitt Leukemia Treated With Rituximab

Shaheen

Mussai

2019

Journal of Pediatric Hematology/Oncology

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“…Although other reports have described single-organ manifestations of enterovirus infection associated with rituximab therapy [ 11 – 13 ], our patient’s case is characterized by an unprecedented multiorgan enterovirus disease, which is in line with a profound immunosuppression by a both functional and numerical B-cell depletion. Severe infectious causes are reported in various types of lymphoma but are more often associated with immunosuppressive therapy, especially antibodies against CD20 receptor such as rituximab or obinutuzumab [ 11 , 14 , 15 ]. Also, individuals with loss of BTK expression are at increased risk for enterovirus infections, although resistance to other viral infections is intact [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Life-threatening disseminated enterovirus infection during combined rituximab and ibrutinib maintenance treatment for mantle cell lymphoma: a case report

et al. 2020

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Background: Rituximab is a well-established component of treatment regimens for B-cell non-Hodgkin lymphoma. Rituximab binds the CD20 antigen on the surface of B lymphocytes, causing an enhanced clearance of malignant and benign B cells. Thus, rituximab leads to depletion of normal B lymphocytes as well, which can cause substantial immunodeficiency. Ibrutinib inhibits the Bruton tyrosine kinase and thereby B-cell activity. It is used for the treatment of different B-lymphocyte malignancies, such as mantle cell lymphoma. Recently, the combination of both drugs has been tested in various clinical scenarios. Case presentation: We present a case of disseminated enterovirus infection resulting from combined rituximab and ibrutinib maintenance treatment in a 57-year-old Caucasian patient. with mantle cell lymphoma. Initially presenting with myositis symptoms, further diagnostic investigation revealed myocarditis, enteritis, myeloencephalitis, and hepatitis. These organ manifestations led to potentially life-threatening complications such as rhabdomyolysis, delirium, and heart rhythm disturbances. After treatment with high-dose intravenous immunoglobulins, virus clearance was achieved and organ functions could be restored. Conclusions: This case emphasizes the risk of combined therapy with rituximab/ibrutinib for severe immunerelated side effects with the necessity of continuous patient monitoring. High-dose intravenous therapy should be considered as treatment for severe enterovirus infection. In severe enterovirus infections, we recommend subtyping for the development of efficient preventive and therapeutic strategies.

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“…Intravenous immunoglobulin (IVIG) was used for 2 patients ( Table ). IVIG has been used for treatment of enterovirus infections, particularly in immunocompromised patients ( 15 ), but the efficacy of IVIG might be limited for treatment of HPeV infection because of low seroprevalence in adults ( 8 ).…”

Section: Discussionmentioning

confidence: 99%