Enterovirus A71 causing meningoencephalitis and acute flaccid myelitis in a patient receiving rituximab

Area of Science:

• Neurology
• Infectious Diseases
• Immunology

Background:

• Rituximab is an immunosuppressive therapy used for rheumatoid arthritis.
• Enteroviral infections can cause severe neurological complications, including meningoencephalitis and acute flaccid myelitis (AFM).
• Enterovirus A71 (EV-A71) is a known neurotropic pathogen.

Observation:

• A young woman undergoing rituximab treatment for rheumatoid arthritis presented with severe meningoencephalitis and AFM.
• Cerebrospinal fluid (CSF) and stool samples confirmed enteroviral infection, identified as EV-A71 by CDC sequencing.
• The patient received intravenous immunoglobulin (IVIg) and fluoxetine for treatment.

Findings:

• The patient experienced a significant clinical improvement following IVIg and fluoxetine therapy.
• This case demonstrates a potential clinical presentation and recovery course for enteroviral meningoencephalitis and AFM in an immunosuppressed individual.
• Diagnostic confirmation relied on RT-PCR testing of CSF and stool, underscoring the importance of multi-site testing.

Implications:

• This case underscores the critical need to consider enteroviral infections in patients receiving rituximab therapy.
• It highlights the potential severity of EV-A71 neurological disease and suggests a possible therapeutic approach.
• Emphasizes the diagnostic value of testing multiple biological samples (CSF, stool, nasopharyngeal swab, blood) for enterovirus detection.