West Nile Virus Neuroinvasive Disease in Patients Treated With Anti-CD20 Therapies.

IF 2.3 Q3 CLINICAL NEUROLOGY

Neurology. Clinical practice Pub Date : 2025-08-01 Epub Date: 2025-06-25 DOI:10.1212/CPJ.0000000000200489

Rumyar V Ardakani, Paul Daniel Crane, Daniel M Pastula, Lakshmi Chauhan, Elizabeth Matthews, Kelli M Money, Anna Shah, Amanda L Piquet, Robert H Gross, Aaron M Carlson, Kenneth L Tyler, John R Corboy, Enrique Alvarez, Andrew B Wolf

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Abstract

Background and objectives: The literature on severe West Nile virus (WNV) neuroinvasive disease (WNND) in patients treated with anti-CD20 therapies is limited. We systematically characterize cases of WNND in the tertiary academic UCHealth system.

Methods: A retrospective cohort (January 2016 to January 2024) of patients with a validated diagnosis of WNND and anti-CD20 medication use was identified with electronic medical record query followed by individual chart review.

Results: We identified 25 patients; multiple sclerosis was the most common indication for anti-CD20 therapy in 13 patients (52%). Twenty-one patients (84%) presented with meningoencephalitis. CSF WNV IgM was positive in 5 of 21 patients (24%) who were tested while 13 of 14 tested patients (93%) had positive reverse-transcription PCR (RT-PCR) findings in the CSF. MRI demonstrated anomalies associated with WNND in 12 of 23 patients (52%) with available imaging. Intensive care unit admission was required in 8 patients (32%), and 12 patients (48%) were treated with intravenous immunoglobulin. Worsening of ≥1 point from pre-WNV baseline modified Rankin Scale (mRS) score to the 90-day postdischarge mRS score was seen in 18 patients (75%). Two patients (8%) died by 90 days.

Discussion: WNND leads to disability accrual in patients on B cell-depleting anti-CD20 therapies. Utilization of RT-PCR is important in optimizing diagnosis in this patient population because of limited sensitivity of the WNV-IgM testing commonly used in the general population.

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抗cd20疗法治疗的西尼罗病毒神经侵袭性疾病患者

背景和目的：关于抗cd20疗法治疗严重西尼罗病毒（WNV）神经侵袭性疾病（WNND）患者的文献有限。我们系统地描述了三级学术卫生系统中的WNND病例。方法：对2016年1月至2024年1月诊断为WNND并使用抗cd20药物的患者进行回顾性队列研究，通过电子病历查询并进行个人病历回顾。结果：我们确定了25例患者；13例（52%）患者中多发性硬化症是抗cd20治疗的最常见适应症。21例（84%）患者表现为脑膜脑炎。经检测的21例患者中有5例（24%）脑脊液WNV IgM阳性，14例患者中有13例（93%）脑脊液逆转录PCR （RT-PCR）阳性。MRI显示23例患者中有12例（52%）与WNND相关。8例（32%）患者需要入住重症监护病房，12例（48%）患者接受静脉注射免疫球蛋白治疗。18例患者（75%）从wnv前基线修正Rankin量表（mRS）评分到出院后90天mRS评分恶化≥1分。2例（8%）在90天内死亡。讨论：WNND导致使用B细胞消耗抗cd20治疗的患者残疾增加。由于一般人群中常用的WNV-IgM检测灵敏度有限，因此利用RT-PCR对优化该患者群体的诊断非常重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology. Clinical practice CLINICAL NEUROLOGY-

CiteScore

4.00

自引率

0.00%

发文量

期刊介绍： Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.