Hepatitis and Encephalitis due to Coxsackie Virus A9 in an Adult

Moreau, Brigitte; Bastedo, Clare; Michel, René P.; Ghali, Peter

doi:10.1159/000333135

Cited by 11 publications

(10 citation statements)

References 12 publications

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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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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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“…It has been described in the literature infrequently in individual case reports from 1962-2001 [11][12][13][14][15][16] .A case report in 2006 detailed a patient who was diagnosed with hepatitis and had a concurrent rise in Coxsackie antibody titers in the serum [15] . More recently, a report from 2009 describes a patient with hepatitis and Coxsackie A9 positivity with peak AST and ALT levels 6 days after development of symptoms [13] . Our patient's liver associated enzyme peak occurred 4 days after symptom onset, with severely elevated AST 7946 Units/L and ALT 5684 Units/L.…”

Section: Discussionmentioning

confidence: 99%

A case of coxsackie B virus infection leading to multi-organ inflammation: Myopericarditis and acute liver failure

Zaheeruddin

Bade

Jani

et al. 2014

CRIM

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Myopericarditis refers to the development of acute pericarditis with myocardial involvement. Viral infections, including Coxsackie B virus, are amongst the most common causes of myopericarditis. The Coxsackie B viruses are known to have a role in the development of a number of clinical diseases including but not limited to cardiac disease, central nervous system infections, ocular infections, pleurodynia, gastrointestinal disease, and viral exanthems. In individual cases, Coxsackie B virus may also be associated with acute hepatitis. We describe a rare case of a 41 year-old female with multi-organ inflammation caused by Coxsackie B virus leading to myopericarditis, pleuritis, and acute liver failure. Laboratory and imaging data helped to make diagnosis of myopericarditis and appropriate management was initiated. Shortly after the patient developed acute liver failure with an INR greater than 13 and AST and ALT of 7946 u/L and 5684 u/L, respectively. Viral serology revealed Coxsackie B 1, 2, and 6 serum antibody positivity (> 1:32 titer) indicating acute or recent infection. A complete workup for other liver failure etiologies was negative. The case shows the significance of awareness and recognition of the possible complications of Coxsackie B virus infection including liver failure.

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“…A neurologic presentation and hepatic involvement have been reported in association with the latter virus [10-12]. …”

Section: Discussionmentioning

confidence: 99%

Hand, foot, and mouth syndrome in an immunocompetent adult: a case report

et al. 2013

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BackgroundHand, foot, and mouth syndrome (HFMS) is a common acute illness. It is characterized by mild clinical symptoms including fever, blisters, and sores in the mouth and on the palms and soles following a 3- to 7-day incubation period. This syndrome is rarely seen in adults.Case presentationA 35-year-old male Caucasian patient had a history of multiple episodes of acute pharyngitis, hypertension, hypercholesterolemia, and occasional abdominal pain. He presented with polyarthralgia in the knees and hands and odynophagia, followed by fever, oral mucosal aphthous lesions, and vesicles on the palms and soles. Three weeks after presentation, he was admitted to the emergency room with acute myocarditis. The in-hospital evaluation revealed positive serology for coxsackie A9 (1:160), positive anti-transglutaminase and anti-gliadin antibodies, normal immunoglobulins, and human immunodeficiency virus negativity.ConclusionWe herein describe a case of HFMS that was associated with coxsackie A9 infection complicated by acute myocarditis. Although an association between celiac disease and HFMS has not been described, this patient’s immunologic disruption could have favored the development of infection and ultimately HFMS.

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Hepatitis and Encephalitis due to Coxsackie Virus A9 in an Adult

Cited by 11 publications

References 12 publications

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

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

A case of coxsackie B virus infection leading to multi-organ inflammation: Myopericarditis and acute liver failure

Hand, foot, and mouth syndrome in an immunocompetent adult: a case report

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