title: Impact of rituximab-associated B-cell defects on West Nile virus meningoencephalitis in solid organ transplant recipients.
abstract: Evidence suggests that West Nile virus (WNV) neuroinvasive disease occurs more frequently in both solid organ and human stem cell transplant recipients. The effect of concomitant anti-B-cell therapy with rituximab, a CD20(+) monoclonal antibody, on WNV infection in this population, however, has not been reported. We describe a case of a patient with alpha-1-antitrypsin deficiency who underwent single lung transplantation in 2005 and was maintained on tacrolimus, cytoxan and prednisone. More recently, she had received two courses of rituximab for recurrent A2-A3 grade rejection with concomitant capillaritis and presented six months later with rapid, fulminant WNV meningoencephalitis. Her diagnosis was made by cerebrospinal fluid (CSF) PCR but serum and CSF WNV IgM and IgG remained negative. She received WNV-specific hyperimmune globulin (Omr-Ig-Am) through a compassionate protocol. She experienced a rapidly progressive and devastating neurological course despite treatment and died three wk after onset of her symptoms. Autopsy revealed extensive meningoencephalomyelitis.
authors: Division of Infectious Diseases, Department of Internal Medicine, University of Colorado Denver, Anschutz Medical Campus, Denver, CO 80045, USA. marilyn.levi@ucdenver.edu
authors: Marilyn E
authors: ME
authors: Levi
authors: Dianna
authors: D
authors: Quan
authors: Joseph T
authors: JT
authors: Ho
authors: B K
authors: BK
authors: Kleinschmidt-Demasters
authors: Kenneth L
authors: KL
authors: Tyler
authors: Todd J
authors: TJ
authors: Grazia
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D001402:B-Lymphocytes / Q000276:immunology; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy; D006801:Humans; D016867:Immunocompromised Host; D007136:Immunoglobulins / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use*; D016040:Lung Transplantation / Q000276:immunology; D008590:Meningoencephalitis / Q000276:immunology / Q000821:virology*; D008875:Middle Aged; D000069283:Rituximab; D014901:West Nile Fever / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D019896:alpha 1-Antitrypsin Deficiency / Q000601:surgery
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007136:Immunoglobulins; D007155:Immunologic Factors; D000069283:Rituximab