Fatal Case of Enterovirus 71 Infection and Rituximab Therapy, France, 2012

Disseminated Enteroviral Infection Associated with Obinutuzumab

“…Early recognition is critical because the infection can be effectively treated with intravenous immunoglobulin (IVIg).We report 2 cases of disseminated enteroviral infections in patients in Australia treated for lymphoma with the CD20 monoclonal antibody (mAb) obinutuzumab. Clinical features, including hepatitis, edema, and a dermatomyositis-like syndrome, were similar to those mentioned in the original descriptions of disseminated enteroviral infections in children with X-linked agammaglobulinemia (XLA) ( 4 , 5 ). …”

“…During the 1970s and 1980s, reports described the clinical manifestation of disseminated enterovirus infection in children with XLA ( 4 , 5 ) and demonstrated that IVIg is an effective therapy for disseminated enterovirus infection ( 7 , 8 ). Since then, reports of disseminated enteroviral infections have been uncommon.…”

“…Twelve months after she began taking obinutuzumab, she sought treatment for fever, headaches, and myalgias. Peripheral blood lymphocyte count was 0.40 × 10 9 cells/L ( 1 , 2 , 4 , 5 ). Cerebrospinal fluid was acellular, but we detected enterovirus in cerebrospinal fluid and feces by using PCR.…”

Coxsackievirus A16 Encephalitis during Obinutuzumab Therapy, Belgium, 2013

“…However, resulting hypogammaglobulinemia predisposes patients to opportunistic infections, including progressive multifocal leukoencephalopathy and enterovirus infections ( 2 , 6 ). MAbs with enhanced activity against CD20 (e.g., obinutuzumab) have been developed.…”

Fatal Coxsackie meningoencephalitis in a patient with B-cell lymphopenia and hypogammaglobulinemia following rituximab therapy

“…4 In contrast, patients with common variable immunodeficiency typically retain circulating B cells and are at lower risk for EM. 9,10 Therefore, in patients with persistent marked B lymphopenia after rituximab, we would predict an increased risk of EM similar to patients with X-linked agammaglobulinemia.…”