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

Palacios, Thamiris; Bartelt, Luther A.; Scheld, W. Michael; Lopes, M. Beatriz; Kelting, Sarah; Holland, Steven M.; Lipkin, W. Ian; Quan, Phenix‐Lan; Borish, Larry; Lawrence, Monica G.

doi:10.1016/j.anai.2015.05.007

Cited by 16 publications

(10 citation statements)

References 11 publications

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“…Ten cases of post‐rituximab enteroviral meningoencephalitis have been sporadically reported in 9 different individual reports (Table ) . Eight patients received rituximab for B‐cell lymphomas and two for autoimmune disorders.…”

Section: Discussionmentioning

confidence: 88%

“…Among the published lymphoma patients, as in ours, the maximum time from treatment to symptoms was six months. By contrast, the two patients with autoimmune disease presented with symptoms 11 months and 10 years after treatment. Similar to our cohort, fever was a common symptom (in seven patients), but cognitive impairment, which was prevalent in seven patients described in the literature, was noted in only two of our patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Enteroviral infection in patients treated with rituximab for non‐Hodgkin lymphoma: a case series and review of the literature

Grisariu

Vaxman

Gatt

et al. 2016

Hematological Oncology

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In recent years, anti-CD20 antibodies have been increasingly used to treat lymphoproliferative and immune disorders. Chronic viral infections are infrequently reported in patients receiving these therapies. Enteroviral infection can cause life-threatening meningoencephalitis and other systemic chronic syndromes in immune deficient patients. We describe the clinical courses and outcomes of 6 patients from 2 tertiary care institutions who developed chronic enteroviral infection with neurological manifestations, after combined chemoimmunotherapy with rituximab for B-cell lymphoma. We review the literature that includes 10 sporadic reported cases of chronic enteroviral meningoencephalitis attributed to rituximab therapy. It is a rare disease, and its diagnosis is often elusive. We propose that low immunoglobulin G levels are the main risk factor for developing chronic enteroviral infection and emphasize the need for a high index of suspicion, early diagnosis, and intervention in this iatrogenic and potentially fatal complication.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Enteroviral infection in patients treated with rituximab for non‐Hodgkin lymphoma: a case series and review of the literature

Grisariu

Vaxman

Gatt

et al. 2016

Hematological Oncology

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“…The two deaths were seen in SCID patients (personal communication with Prof. Waleed Al-Herz, MD). In addition, NPEV meningoencephalitis and/or septicemia were reported in few cases with either primary B cell deficiency such as B cell linker (BLINK) protein deficiency [ 243 ] or acquired B cell deficiency following the administration of anti-CD20 (rituximab) [ 244 , 245 ]. In all reports, better outcome was attributed to the early administration of high doses of IVIG during NPEV viremia [ 246 ].…”

Section: Section 2: Specific Infections Of Concern In Piddmentioning

confidence: 99%

Emerging Infections and Pertinent Infections Related to Travel for Patients with Primary Immunodeficiencies

et al. 2017

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In today’s global economy and affordable vacation travel, it is increasingly important that visitors to another country and their physician be familiar with emerging infections, infections unique to a specific geographic region, and risks related to the process of travel. This is never more important than for patients with primary immunodeficiency disorders (PIDD). A recent review addressing common causes of fever in travelers provides important information for the general population Thwaites and Day (N Engl J Med 376:548-560, 2017 ). This review covers critical infectious and management concerns specifically related to travel for patients with PIDD. This review will discuss the context of the changing landscape of infections, highlight specific infections of concern, and profile distinct infection phenotypes in patients who are immune compromised. The organization of this review will address the environment driving emerging infections and several concerns unique to patients with PIDD. The first section addresses general considerations, the second section profiles specific infections organized according to mechanism of transmission, and the third section focuses on unique phenotypes and unique susceptibilities in patients with PIDDs. This review does not address most parasitic diseases. Reference tables provide easily accessible information on a broader range of infections than is described in the text.

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“…Several cases of rituximab-related brainstem encephalitis have been reported in the literature (see table 1). 9–19 Many of these cases were also undergoing concurrent immunosuppression with other chemotherapeutic agents or as part of a previous stem cell transplant. Nevertheless, the rituximab was often the most recent agent, as in our case.…”

Section: Discussionmentioning

confidence: 99%

Brainstem encephalitis caused by Coxsackie A16 virus in a rituximab-immunosuppressed patient

Smail¹,

O’Neill

Andresen

2019

BMJ Case Rep

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Rituximab and other B cell depleting agents are increasingly used for haematological, immunological and neurological diseases. In a small minority, immunosuppression leads to increased virulence of normally mild infections. Brainstem encephalitis has been described occurring after infection from enteroviruses, more commonly in the paediatric population, but also in immunosuppressed adults. In this paper, we describe an enteroviral brainstem encephalitis in a rituximab-immunosuppressed patient. The enterovirus identified was Coxsackie A16, which has never yet been reported to cause brainstem encephalitis in an adult.

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

Cited by 16 publications

References 11 publications

Enteroviral infection in patients treated with rituximab for non‐Hodgkin lymphoma: a case series and review of the literature

Enteroviral infection in patients treated with rituximab for non‐Hodgkin lymphoma: a case series and review of the literature

Emerging Infections and Pertinent Infections Related to Travel for Patients with Primary Immunodeficiencies

Brainstem encephalitis caused by Coxsackie A16 virus in a rituximab-immunosuppressed patient

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