This case highlights the risk of enteroviral encephalitis in patients receiving rituximab for lymphoma and demonstrates successful treatment with intravenous immunoglobulin.
Clinicians should consider EV CNS infection in rituximab-treated pediatric leukemia; this single case leaves open IVIG efficacy.
A boy with central nervous system relapse of Burkitt leukemia developed fever and neurologic symptoms and cognitive impairment. He had received multi-drug chemotherapy including rituximab. Enterovirus (EV) was detected in cerebrospinal fluid by polymerase chain reaction, and magnetic resonance imaging findings were consistent with viral infection. The patient was treated with intravenous immunoglobulin and within 1 month cleared his EV. Rituximab can cause a profound B-cell deficiency predisposing patients to infections including EV encephalitis. This is the first report of enteroviral encephalitis in a child undergoing treatment for lymphoma with rituximab and suggests the need to watch for this complication of therapy.
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Shaheen et al. (2018) studied this question.
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