Two Cases of Severe Tick-Borne Encephalitis in Rituximab-Treated Patients in Germany: Implications for Diagnosis and Prevention

Abstract

Rituximab (RTX) has become a standard therapy for certain B cell malignancies and autoimmune diseases. We report 2 RTX-treated patients who developed severe tick-borne encephalitis virus (TBEV) infection. The inability to generate new antibody responses renders RTX-treated patients susceptible to TBEV, impedes laboratory diagnosis, and necessitates preventive vaccination in endemic areas.

Mild COVID-19 infection despite chronic B cell depletion in a patient with aquaporin-4-positive neuromyelitis optica spectrum disorder.

“…There are reports of severe and even fatal viral infections in patients on rituximab. These include encephalitis due to Coxsackie A16 9 , Enterovirus (Sham et al, 2019) (Kassab et al, 2013), Powassan (Solomon et al, 2018), Tick-Borne Encephalitis (Steininger et al, 2017), West Nile (Morjaria et al, 2015), JCV neurological disease including PML (Ishikawa et al, 2018) (Berger et al, 2018) and granule cells neuronopathy (Dang et al, 2014). Our patient did not present any new neurological signs or symptoms and there was no indication for a lumbar puncture.…”

Impfen bei Immundefizienz

“…Verschiedene Fallberichte deuten auf schwerwiegende oder gar tödliche Verläufe von FSME-Infektionen bei immunsupprimierten PatientInnen hin [165,203,337].…”

Severe tick-borne encephalitis in a patient recovered from COVID 19

“…Sometimes concomitant infection with B. burgdorferi sensu lato occurs, which may impact the course of the infection ( Oksi et al, 1993 ). Mostly immunosuppressant treatments affect the frequency of infections, especially viral ones Steininger et al (2017) . reported two cases of severe TBE in patients who were undergoing rituximab treatment.…”