Why the study?
Immunosuppression from B cell depleting agents like rituximab can increase the virulence of normally mild infections, but Coxsackie A16 had never been reported to cause brainstem encephalitis in an adult.
High-dose intravenous immunoglobulin may be an effective treatment for severe enteroviral brainstem encephalitis in immunosuppressed adults.
Hypothesis-generating for IVIG in severe enteroviral brainstem encephalitis; leaves open need for controlled trials before practice change.
Rituximab and other B cell depleting agents are increasingly used for haematological, immunological and neurological diseases. In a small minority, immunosuppression leads to increased virulence of normally mild infections. Brainstem encephalitis has been described occurring after infection from enteroviruses, more commonly in the paediatric population, but also in immunosuppressed adults. In this paper, we describe an enteroviral brainstem encephalitis in a rituximab-immunosuppressed patient. The enterovirus identified was Coxsackie A16, which has never yet been reported to cause brainstem encephalitis in an adult.
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Smail et al. (2019) studied this question.
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