title: Clinical, neuropathological and radiological evidence for a rare complication of rituximab therapy.
abstract: We report a rare case of myofasciitis and meningitis with deafness caused by systemic enterovirus infection in the setting of hypogammaglobulinaemia induced by rituximab. Whilst effective and generally safe, anti- CD 20 antibody therapy is increasingly recognised to result in unusual infectious complications to be considered in a treated patient presenting with neurological symptoms. These cases may pose diagnostic difficulties and can have atypical presentations. We present this rare complication of rituximab therapy, with histopathological confirmation of myofasciitis. In the older literature, enterovirus associated myofasciitis may have erroneously been termed dermatomyositis and we review the literature to demonstrate this important nosological point.
authors.affiliation: Department of Molecular Neurosciences, UCL Institute of Neurology, MRC Centre for Neuromuscular Diseases, London, UK.
authors.forename: E G
authors.initials: EG
authors.lastname: Healy
authors.affiliation: Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Phadke
authors.affiliation: Department of Virology, University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Kidd
authors.affiliation: Department of Molecular Neurosciences, UCL Institute of Neurology, MRC Centre for Neuromuscular Diseases, London, UK; Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: M M
authors.initials: MM
authors.lastname: Reilly
authors.affiliation: Department of Molecular Neurosciences, UCL Institute of Neurology, MRC Centre for Neuromuscular Diseases, London, UK; Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK. Electronic address: michael.lunn@uclh.nhs.uk.
authors.forename: M P
authors.initials: MP
authors.lastname: Lunn
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003638:Deafness / Q000209:etiology / Q000473:pathology; D004769:Enterovirus Infections / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D005208:Fasciitis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy; D008297:Male; D008587:Meningitis, Viral / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D018482:Muscle, Skeletal / Q000473:pathology; D009220:Myositis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D000069283:Rituximab / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D000069283:Rituximab
keywords: Echovirus; Hypogammaglobulinaemia; Meningitis; Myofasciitis; Rituximab