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Updated: Jul 14, 2025
Isolating Central Nervous System Tissues and Associated Meninges for the Downstream Analysis of Immune cells
Published on: May 19, 2020
Chronic Enterovirus Meningoencephalitis in Prolonged B-Cell Depletion After Rituximab Therapy: Case Report
Clemens Jacksch1, Justina Dargvainiene2, Sindy Böttcher2
1From the Klinik für Neurologie (C.J., F.L., K.S., D.B., E.S.); Institut für Klinische Chemie (J.D., F.L.), Universitätsklinikum Schleswig-Holstein, Kiel/Lübeck; and Robert Koch Institut (S.B., S.D.), Nationales Referenzzentrum für Poliomyelitis und Enteroviren, Berlin, Deutschland. clemensjacksch@googlemail.com.
Objectives:
Persistent impaired immunity is possible even years after B-cell depleting therapies. This may favor the occurrence of infections, including infectious meningitis and encephalitis. In this study, we report a case of chronic enterovirus meningoencephalitis in prolonged B-cell depletion years after rituximab therapy.
Methods:
This is a case report from a German academic hospital. In addition to repeated clinical examinations, repeated brain MRI and extended CSF and laboratory diagnostics were performed. We used the CARE checklist when writing our report.
Results:
A 38-year-old man presented with high fever (>40°C), severe headache, and progressive neurologic and cognitive deficits. As result of previous lymphoma therapy with rituximab years ago, prolonged B-cell aplasia was detected. To restore humoral immunity, the patient received repeated infusions of immunoglobulins. In the end, a complete restitution of the physical and mental condition was achieved with the established therapy.
Discussion:
This case report should emphasize the importance of assessing humoral immunity even years after B-cell depletion therapy, especially in case of opportunistic infections.
