Chronic Enterovirus Meningitis with Acute Hepatitis in a Patient with Chronic Lymphocytic Leukemia Treated with Venetoclax/Obinutuzumab: A Case Report.

Abstract

Introduction: Enterovirus infection is typically asymptomatic with rapid host clearance. However, several cases of disseminated enterovirus infection in oncologic patients with obinutuzumab-induced hypogammaglobulinemia have been reported in the literature, the majority of whom developed symptoms while actively receiving obinutuzumab.

Case presentation: We present a patient with hypogammaglobulinemia, likely induced by obinutuzumab for chronic lymphocytic leukemia, found to have enterovirus meningitis and hepatitis, with elevated transaminases, headache, and relapsing fevers as primary manifestations of disease. This is the first reported case of a patient developing disseminated enterovirus infection 1 year after discontinuation of obinutuzumab course. After diagnosis, the patient was started on intravenous immune globulin therapy with improvement in symptoms and laboratory abnormalities.

Conclusion: Physicians should maintain a high index of suspicion for enterovirus infection in venetoclax/obinutuzumab-treated oncologic patients presenting with nonspecific symptoms including cyclic fevers, headache, myalgias, and elevated liver function tests. Lumbar puncture should be conducted early in the presentation in patients reporting headache or other central nervous system symptoms.