Chronic meningoencephalitis due to enterovirus A71 complicating rituximab therapy.

IF 2.3 4区 医学 Q2 CLINICAL NEUROLOGY
A David, M Claudé, G Martin de Frémont, G Trédez, C Henry
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引用次数: 0

Abstract

Background: Rituximab and other anti-CD20 therapies are increasingly used in the treatment of autoimmune and hematologic disorders. These treatments are associated with persistent immune impairment, potentially leading to severe infections. We describe a resolutive case of proven chronic enterovirus A71 (EV A71) meningoencephalitis complicating rituximab maintenance therapy for non-Hodgkin lymphoma.

Methods: This article combines an original case report and a literature review of cases of enteroviral meningoencephalitis complicating rituximab treatment.

Results: A 38-year-old man was treated with rituximab and chemotherapy for a mantle cell lymphoma. During maintenance treatment with rituximab, he developed a "hand-foot-mouth disease", and one month later severe neurological deterioration including quadriparesis and major neurocognitive disorder leading to a diagnosis of chronic enteroviral meningoencephalitis. A treatment associating monthly intravenous immunoglobulins (IVIg) and fluoxetine was initiated two months after neurological symptoms onset, resulting in dramatic clinical improvement within six months. A brief literature review shows that a treatment with high-dose IVIg often results in clinical improvement. Fluoxetine was added in recent reports based on in vitro evidence of anti-viral activity against enteroviruses.

Discussion: Enteroviral infection should be evoked in patients treated with rituximab presenting with an encephalitic symptomatology, and restoring humoral immunity with high-dose IVIg might improve their condition.

肠病毒A71引起的慢性脑膜脑炎合并利妥昔单抗治疗。
背景:利妥昔单抗和其他抗cd20疗法越来越多地用于自身免疫性疾病和血液系统疾病的治疗。这些治疗与持续的免疫损伤有关,可能导致严重的感染。我们描述了一个确诊的慢性肠病毒A71 (EV A71)脑膜脑炎合并利妥昔单抗维持治疗非霍奇金淋巴瘤的决定性病例。方法:本文结合一例原始病例报告和文献复习肠病毒性脑膜脑炎合并利妥昔单抗治疗的病例。结果:一名38岁的男性接受了利妥昔单抗和化疗治疗套细胞淋巴瘤。在利妥昔单抗维持治疗期间,他出现了“手足口病”,一个月后,严重的神经系统恶化,包括四肢瘫和严重的神经认知障碍,导致诊断为慢性肠病毒脑膜脑炎。在神经系统症状出现两个月后开始每月静脉注射免疫球蛋白(IVIg)和氟西汀治疗,6个月内临床显著改善。一篇简短的文献综述显示,高剂量IVIg治疗通常会导致临床改善。根据对肠道病毒的体外抗病毒活性证据,在最近的报告中添加了氟西汀。讨论:在接受利妥昔单抗治疗的患者出现脑病症状时应引起肠病毒感染,使用大剂量IVIg恢复体液免疫可能改善其病情。
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
Revue neurologique
Revue neurologique 医学-临床神经学
CiteScore
4.80
自引率
0.00%
发文量
598
审稿时长
55 days
期刊介绍: The first issue of the Revue Neurologique, featuring an original article by Jean-Martin Charcot, was published on February 28th, 1893. Six years later, the French Society of Neurology (SFN) adopted this journal as its official publication in the year of its foundation, 1899. The Revue Neurologique was published throughout the 20th century without interruption and is indexed in all international databases (including Current Contents, Pubmed, Scopus). Ten annual issues provide original peer-reviewed clinical and research articles, and review articles giving up-to-date insights in all areas of neurology. The Revue Neurologique also publishes guidelines and recommendations. The Revue Neurologique publishes original articles, brief reports, general reviews, editorials, and letters to the editor as well as correspondence concerning articles previously published in the journal in the correspondence column.
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