Patients on long-term anti-CD20 monotherapy may be at risk for chronic, fatal enterovirus infections that can manifest as fulminant myocarditis months after an initial mild presentation.
We report a fatal case of coxsackievirus B4 chronic infection in a 30-year-old woman with a diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disorder controlled by rituximab monotherapy for 3 years. Initially presenting as self-limited meningitis, the infection remained silent for 8 months before the sudden onset of fulminant myocarditis. Analysis of the complete genome showed that the same virus was responsible for both episodes.
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Lucıanı et al. (2020) studied this question.
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