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Development of Enteroviral Aseptic Meningitis After Rituximab Treatment of Non-Hodgkin Lymphoma

Givens, Priscilla BS; Velez, Ana Paula MD*; Sandin, Ramon L. MD, MS, FCAP†‡; Quilitz, Rod E. PharmD, BCOP§; Greene, John N. MD, FACP§∥

Infectious Diseases in Clinical Practice: July 2012 - Volume 20 - Issue 4 - p 291–293
doi: 10.1097/IPC.0b013e3182506ea0
Case Reports

Rituximab is a monoclonal antibody intended for the treatment of various autoimmune conditions as well as B-cell lymphoid malignancies. It is targeted to the CD20 antigen, which induces apoptosis in mature B cells, making it a useful therapeutic agent against B-cell lymphoid malignancies when used in conjunction with cytotoxic chemotherapy regimens such as cyclophosphamide, hydroxydaunorubicin (doxorubicin), Oncovin (vincristine; Hospira Inc, Lake Forest Ill), and prednisone/prednisolone. It is a very successful treatment of B-cell malignancies but causes profound immunosuppression and elevates the risk of opportunistic infections such as enterovirus meningitis. We report a case of aseptic meningitis in a patient with non-Hodgkin lymphoma after treatment with rituximab in combination with cytotoxic chemotherapy and successful treatment with intravenous immunoglobulin therapy.

Prolonged periods of B-cell deficiency caused by rituximab increases the risk for infections by attacking the antibodies which are the body’s natural protection against some of the viral infections such as enterovirus. Givens et al. report a case of persistent enterovirus meningoencephalitis in patient with NHL after rituximab therapy. The patient was successfully treated with intravenous immunoglobulin with complete resolution of the symptoms.

From the *Division of Infectious Diseases and International Medicine, Department of Internal Medicine, University of South Florida College of Medicine; †Clinical Microbiology and Virology Laboratories, H. Lee Moffitt Cancer Center and Research Institute; ‡Department of Pathology and Oncologic Sciences, University of South Florida College of Medicine; §Division of Infectious Diseases, H. Lee Moffitt Cancer Center and Research Institute; ∥Department of Internal Medicine and Interdisciplinary Oncology, University of South Florida College of Medicine, Tampa, FL.

Correspondence to: John N. Greene, MD, FACP, Division of Infectious Diseases, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, FOB-3, Tampa, FL 33612-9497. E-mail:

The authors have no funding or conflicts of interest to disclose.

Priscilla Givens is a medical student at the University of South Florida, Tampa, FL.

© 2012 Lippincott Williams & Wilkins, Inc.