title: A Case of Fulminant Hepatitis due to Echovirus 9 in a Patient on Maintenance Rituximab Therapy for Follicular Lymphoma.
abstract: Rituximab is a CD20 monoclonal antibody commonly used in the treatment of haematological malignancies. It causes lymphopenia with subsequent compromised humoral immunity resulting in an increased risk of infection. A number of infections and viral reactivations have been described as complicating Rituximab therapy. We report an apparently unique case of echovirus 9 (an enterovirus) infection causing an acute hepatitis and significant morbidity in an adult patient on maintenance treatment of Rituximab for follicular lymphoma. We also describe potential missed opportunities to employ more robust screening for viral infections which may have prevented delays in the appropriate treatment and thus may have altered the patient's clinical course. We also make suggestions for lowering the threshold of viral testing in similar patients in the future.
authors.affiliation: Worthing District General Hospital, Western Sussex Hospitals NHS Foundation Trust, Lyndhurst Road, Worthing BN11 2DH, UK.
authors.forename: Ceri
authors.identifier: 0000-0002-3404-0241
authors.initials: C
authors.lastname: Morgan
authors.affiliation: Worthing District General Hospital, Western Sussex Hospitals NHS Foundation Trust, Lyndhurst Road, Worthing BN11 2DH, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Thomson
authors.affiliation: Worthing District General Hospital, Western Sussex Hospitals NHS Foundation Trust, Lyndhurst Road, Worthing BN11 2DH, UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Legg
authors.affiliation: Worthing District General Hospital, Western Sussex Hospitals NHS Foundation Trust, Lyndhurst Road, Worthing BN11 2DH, UK.
authors.forename: Santosh
authors.initials: S
authors.lastname: Narat