Enteroviral Meningoencephalitis as a Complication of Rituximab Therapy for Rheumatoid Arthritis

Area of Science:

• Neurology
• Immunology
• Infectious Diseases

Background:

• Rituximab, an anti-CD20 monoclonal antibody, is used for hematologic malignancies and autoimmune diseases like rheumatoid arthritis.
• B-cell depletion from rituximab can lead to hypogammaglobulinemia, increasing susceptibility to viral infections.
• Enteroviral meningoencephalitis is a rare but serious complication associated with rituximab therapy.

Observation:

• A 37-year-old female with rheumatoid arthritis treated with rituximab presented with fever, headache, confusion, and tremor.
• Brain MRI was unremarkable, but cerebrospinal fluid analysis revealed lymphocytic pleocytosis and enterovirus detection via PCR.
• The patient experienced significant symptom improvement after a five-day course of intravenous immunoglobulin (IVIG).

Findings:

• This case represents the first documented instance of enteroviral meningoencephalitis in a patient treated with rituximab for rheumatoid arthritis.
• Enterovirus infection can manifest as severe meningoencephalitis in rituximab-treated patients, irrespective of the underlying condition.
• Intravenous immunoglobulin (IVIG) therapy may be effective in managing enteroviral meningoencephalitis in this patient population.

Implications:

• Patients receiving rituximab therapy are at risk for severe outcomes from typically self-limited viral infections.
• This case underscores the importance of considering viral meningoencephalitis in rituximab users presenting with neurological symptoms.
• The potential therapeutic role of IVIG in treating rituximab-associated enteroviral meningoencephalitis warrants further investigation.