Abstract
BackgroundEnterovirus has been described as a cause of aseptic meningitis in humorally immunosuppressed patients.Case presentationA 67-year-old female with a history of mantle cell lymphoma on rituximab therapy presented with subacute hepatitis, myalgias, and sensorineural hearing loss several months after an initial febrile illness. She was diagnosed with enterovirus infection by CSF PCR as a unifying etiology of her presentation, representing an unusual presentation of disease.Discussion and conclusionsThis patient’s unique presentation and clinical course presents important implications in the care of similarly immunosuppressed patients with cryptic complaints.
Highlights
Enterovirus has been described as a cause of aseptic meningitis in humorally immunosuppressed patients.Case presentation: A 67-year-old female with a history of mantle cell lymphoma on rituximab therapy presented with subacute hepatitis, myalgias, and sensorineural hearing loss several months after an initial febrile illness
While the vast majority of enteroviral infections in adults result in asymptomatic disease with a rapidly clearing viremia, there have been several documented cases of severe, central nervous system (CNS)-predominant chronic enterovirus infections in patients with primary or iatrogenic hypogammaglobulinemia [1,2,3,4,5]
To report the clinical course and diagnosis of aseptic meningitis, subacute hepatitis, and myositis caused by a unique presentation of disseminated enterovirus infection in a humorally immunosuppressed patient
Summary
Enteroviruses are RNA viruses within the Picornaviridae family that are ubiquitous and commonly passed between humans via the fecal–oral route. The “minor” phase of viremia occurs during which the viruses spread to the lymphoid tissues of the body for further replication. This ongoing replication contributes to the “major” phase of viremia, which is responsible for the majority of clinical symptoms as well as viral seeding of target tissues including the central nervous system (CNS). While the vast majority of enteroviral infections in adults result in asymptomatic disease with a rapidly clearing viremia, there have been several documented cases of severe, CNS-predominant chronic enterovirus infections in patients with primary or iatrogenic hypogammaglobulinemia [1,2,3,4,5]. Anderson et al BMC Infectious Diseases (2022) 22:16 rituximab therapy, as a treatment for hematologic malignancy, with severe enteroviral infection [3, 4]
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