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- W2897812407 abstract "Objective: Present the case of a patient with a chronic meningoencephalitis caused by enterovirus, likely related to rituximab therapy. Background: Enteroviral chronic meningoencephalitis is an infrequent condition seen in patients with hummoral immunodeficiency, congenital or acquired. Design/Methods: Description of a clinical case and systematic review of literature Results: A 66-year-old man treated with Rituximab for Waldenstrom Macroglobulinemia, who had been successfully treated with R-CHOP 6 years previously. The patient presented with drowsiness and fever. Neurological examination showed mild encephalopaty with no focal signs. Laboratory workup: moderate lymphopenia with B-lymphocytes depletion. Serial brain MRIs: corticosubcortical atrophy without signs of inflammation. CSF revealed mild mononuclear pleocytosis and hyperproteinorrachia, with normal-glucose levels. Viruses real-time PCR, including enterovirus, bacterial and fungal cultures on CSF, were all negative. The diagnosis was a subacute meningoencephalitis; infectious, inflammatory and neoplastic etiologies were considered. As no etiologic agent was identified, an immunomediated condition was suspected and methylprednisolone and IV-immunoglobuline were started without improvement. In order to rule out a treatable disorder, a right temporal lobe biopsy was performed. The histologic features included astrogliosis, meningeal and parenchymal infiltration with T cells, with no B cells present. Microglial nodules and neuronophagia were also identified. Enterovirus detection by RT-PCR was positive on brain tissue. Rituximab was discontinued and the patient was treated again with IV-immunoglobulines, without experiencing clinical improvement. He finally died of pneumonia, seven months after the meningoencephalitis debut. Eleven cases of enteroviral T-cell encephalitis related to rituximab have been published since 2003, when the first case was reported. Only in one of the reported cases, it was necessary to perform a brain biopsy for the diagnosis. Conclusions: A negative result of enterovirus-PCR in CSF does not exclude the diagnosis. In cases of chronic meningoencephalitis with unknown etiology, the brain biopsy may be the key for the diagnosis, even if macroscopic lesions are not identified. Disclosure: Dr. Garzo Caldas has nothing to disclose. Dr. Vila Bedmar has nothing to disclose. Dr. Llamas has nothing to disclose. Dr. Ruiz Morales has nothing to disclose. Dr. Hernandez Lain has nothing to disclose. Dr. Folgueira Lopez has nothing to disclose. Dr. Ruiz-Beato has nothing to disclose. Dr. Rodriguez Lopez has nothing to disclose. Dr. Panades Oliveira has nothing to disclose. Dr. Uriarte Perez de Urabayen has nothing to disclose. Dr. Villarejo Galende has nothing to disclose." @default.
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- W2897812407 date "2018-04-10" @default.
- W2897812407 modified "2023-09-26" @default.
- W2897812407 title "Enteroviral T-Cell Encephalitis Related to Immnuosupresive Therapy Including Rituximab (P5.112)" @default.
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