Fatal Case of Enterovirus 71 Infection and Rituximab Therapy, France, 2012

摘要

To the Editor: Enterovirus 71 (EV-71) causes primarily asymptomatic or benign infections in children <5 years of age. However, it may cause severe and sometimes fatal neurologic complications, such as brainstem encephalitis and polio-like paralysis (1). Over the last 15 years, large outbreaks of EV-71 infection have been described in the Asia–Pacific region, associated with the regular emergence of new genetic lineages (2). Since the 1978 outbreak in Hungary, rare sporadic cases have been reported in Europe (1). In France, during 2000–2009, a total of 81 hospitalized patients with EV–17 infection were reported by the sentinel surveillance system, including 2 child deaths, 1 due to proven rhombencephalitis (3,4). We report here a fatal case of EV- 71 rhombencephalitis in an immunocompromised adult who was receiving rituximab therapy. Rituximab is a chimeric anti-CD20 monoclonal antibody that is widely used for treating B-cell lymphoma and an increasing number of autoimmune diseases. Since rituximab became commercially available, several infectious side-effects for the drug have been reported, including hepatitis B reactivation, progressive multifocal leukoencephalopathy, and enteroviral meningoencephalitis (5). The first 2 cases of rituximab-associated enteroviral meningoencephalitis were reported in 2003 (6), and 5 additional cases have been reported to date (7,8).