title: Enteroviral infection in patients treated with rituximab for non-Hodgkin lymphoma: a case series and review of the literature.
abstract: In recent years, anti-CD20 antibodies have been increasingly used to treat lymphoproliferative and immune disorders. Chronic viral infections are infrequently reported in patients receiving these therapies. Enteroviral infection can cause life-threatening meningoencephalitis and other systemic chronic syndromes in immune deficient patients. We describe the clinical courses and outcomes of 6 patients from 2 tertiary care institutions who developed chronic enteroviral infection with neurological manifestations, after combined chemoimmunotherapy with rituximab for B-cell lymphoma. We review the literature that includes 10 sporadic reported cases of chronic enteroviral meningoencephalitis attributed to rituximab therapy. It is a rare disease, and its diagnosis is often elusive. We propose that low immunoglobulin G levels are the main risk factor for developing chronic enteroviral infection and emphasize the need for a high index of suspicion, early diagnosis, and intervention in this iatrogenic and potentially fatal complication.
authors.affiliation: Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Grisariu
authors.affiliation: Hematology Division Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Israel.|Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Vaxman
authors.affiliation: Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Gatt
authors.affiliation: Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Elias
authors.affiliation: Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: B
authors.initials: B
authors.lastname: Avni
authors.affiliation: Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Arad
authors.affiliation: Hematology Division Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Israel.|Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Pasvolsky
authors.affiliation: Hematology Division Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Israel.|Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: P
authors.initials: P
authors.lastname: Raanani
authors.affiliation: Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.|School of Public Health, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Paltiel
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects / Q000627:therapeutic use; D000074322:Antineoplastic Agents, Immunological / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D015415:Biomarkers; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D004769:Enterovirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D000069283:Rituximab / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000074322:Antineoplastic Agents, Immunological; D015415:Biomarkers; D016756:Immunoglobulins, Intravenous; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: enterovirus; lymphoma; review; rituximab