Enteroviral meningoencephalitis in a patient with non-Hodgkin's lymphoma treated previously with rituximab

Abstract

A 75-year-old man, with a long history of recurrent lymphoplasmacytoid lymphoma, presented with diffuse large-cell lymphoma affecting adrenal glands and causing severe hypoadrenalism. The lymphoma responded to rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) chemotherapy. Seven months postcompletion of chemotherapy, he developed signs of gastroenteritis and septicaemia. He deteriorated 24 h postadmission with a significant fall in Glasgow Coma Scale Score. Polymerase chain reaction testing of cerebrospinal fluid suggested enteroviral encephalitis. He responded symptomatically to intravenous immunoglobulins. His immunoglobulin levels were monitored weekly and supplemented to maintain immunoglobulin G level at 10 g/l, but in spite of this, his neurological condition deteriorated and he died after 14 weeks. Rituximab can cause prolonged B-cell deficiency. We speculate that profound immunosuppression induced by rituximab, together with previous chemotherapy, predisposed this patient to fatal enteroviral meningoencephalitis.

Risk of infection in patients with lymphoma receiving rituximab: systematic review and meta-analysis

“…Severe herpes virus reactivation (for example, cytomegalovirus [18-20] and varicella zoster [20,21]) has been reported in several patients. Potentially lethal enteroviral encephalitis has been described after R-C in patients with ML [22-24]. Papovavirus infections have been linked to R-containing therapies in rare case reports.…”

Enteroviral meningoencephalitis as complication of Rituximab therapy in a patient treated for diffuse large B‐cell lymphoma

“…In contrast with other viral infections, enterovirus infection is controlled mainly by neutralizing antibodies (Padate & Keidan, 2006). The first cases of enteroviral meningoencephalitis were reported in patients suffering from congenital agammaglobulinaemia (Quartier et al, 2000).…”

Development of Enteroviral Aseptic Meningitis After Rituximab Treatment of Non-Hodgkin Lymphoma

“…11 Studies also show that the duration of B-cell deficiency remains unchanged in the 8-week retreatment course with rituximab compared to the 4-week course. 2 Currently, there is no specific treatment available for enteroviral meningitis, but pleconaril therapy has been researched for efficacy in shortening symptom time and viral titer in the body. 12 Prolonged periods of B-cell deficiency caused by rituximab increase the risk of infections, especially in patients who are already severely immunosuppressed from simultaneous chemotherapy.…”