A102-12 Hand, Foot, Mouth... and Lung? A Case of Disseminated Coxsackie Virus

Coxsackieviruses are ubiquitous single-stranded RNA viruses from the genus Enterovirus responsible for the illness commonly known as “hand, foot, and mouth disease”. Usually self-limiting, this viral illness is more common in children and results in cutaneous lesions that are highly contagious. In immunocompromised individuals, this can rarely result in disseminated disease involving many different organ systems. We present a unique case of a patient receiving anti-CD20 therapy who subsequently suffered from Coxsackievirus with multi-organ involvement. A 37-year-old transgender female with a past medical history of multiple sclerosis on ublituximab presented to the emergency department with dyspnea. The patient was recently diagnosed with pneumonia at an urgent care and treated with amoxicillin and azithromycin, but their symptoms persisted prompting them to seek further evaluation. CT scan of the chest showed bilateral diffuse ground glass infiltrates consistent with atypical pneumonia. Initial workup including blood cultures, respiratory PCR, sputum culture, and urine antigens were all negative. The patient underwent bronchoscopy with bronchoalveolar lavage and PCR, which subsequently resulted positive for enterovirus. Additionally, the patient was complaining of significant headaches and underwent lumbar puncture which also was positive for enterovirus. Further history obtained from the patient revealed a positive sick contact with coxsackievirus following their child having this illness. The patient was initiated on steroids for the respiratory symptoms and treated with supportive care for their meningitis. The patient’s symptoms improved and they were discharged with outpatient neurology follow-up to discuss considerations for stopping ublituximab.Ublituximab, an anti-CD20 therapy for treatment of multiple sclerosis, increases the risk for certain infections including viral illnesses with case reports confirming this association. As mentioned, coxsackie viruses typically result in a self-limiting cutaneous illness commonly seen in children. Presentation of this disseminated disease can take many forms, including diffuse ground-glass opacities consistent with atypical pneumonia, headache and confusion and CSF studies consistent with viral meningitis, or even fulminant myocarditis in extreme cases. As immunomodulating and immunosuppressive medications become approved for treatment of more disease processes, the risk of atypical presentations of common illnesses is likely to increase. This case highlights the importance of informing patients of the risks of these medications and one of the possible adverse effects of these modern therapies. This abstract is funded by: None