Delayed-onset flaccid paralysis related to west Nile virus reactivation following treatment with rituximab: a case report

BMC Research Notes

Dimitrios Karussis¹  Asaf Honig¹ 

[1] Department of Neurology, Laboratory of Neuroimmunology and Agnes Ginges Center for Neurogenetics and Multiple Sclerosis, Hadassah-Hebrew University Hospital, Ein-Karem, Il-91120 Jerusalem, Israel

关键词: Poliomyelitis;    Delayed immune reaction;    Rituximab;    Acute flaccid paralysis;    West Nile virus;   

Others  :  1118158
DOI  :  10.1186/1756-0500-7-852

 received in 2014-03-03, accepted in 2014-11-06,  发布年份 2014

【 摘 要 】

Background

Neurological manifestations of West Nile virus infection include meningitis, encephalitis and acute flaccid paralysis. Typically, West Nile virus-associated acute flaccid paralysis is characterized by acute and rapidly progressing limb weakness, occurring early in the course of the disease.

Case presentation

We report a patient of Yemenite descent who developed West Nile virus-encephalitis and poliomyelitis two weeks following treatment with rituximab for B cell lymphoma, and delayed encephalitis with ascending demyelinating polyneuropathy 6 months later. Diagnosis of the first episode was based on a high West Nile virus copy number in the blood polymerase chain reaction. During the second episode the patient developed encephalitis and flaccid asymmetric quadriparesis, accompanied by high IgM anti-West Nile virus titers in the blood and cerebrospinal fluid.

Conclusion

The delayed polyneuropathy post-West Nile virus infection and encephalitis/poliomyelitis may be related to reactivation of the virus or to a delayed autoimmune (post-infectious) process, possibly accelerated by the recovering B-cell humoral immunity, 6 months after treatment with rituximab. This case depicts the complexities of the immune responses and their reconstitution following monoclonal antibody treatment and the diversity of neurological syndromes associated with West Nile virus infection.

【 授权许可】

   
2014 Honig and Karussis; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Mostashari F, Bunning M, Kitsutani P, Singer D, Nash D, Cooper M, Katz N, Liljebjelke K, Biggerstaff B, Fine A, Layton M, Mullin S, Johnson A, Martin D, Hayes E, Campbell G: Epidemic West Nile Encephalitis, New York, 1999: results of a household-based seroepidemiological survey. Lancet 1999, 2001(358):261-264.
• [2]Sejvar J, Davis L, Szabados E, Jackson A: Delayed-onset and recurrent limb weakness associated with West Nile virus infection. J Neurovirol 2010, 16(1):93-100.
• [3]Murray K, Walker C, Herrington E, Lewis J, Mccormick J, Beasley D, Tesh R, Fisher-Hoch S: Persistent Infection with West Nile virus years after initial infection. J Infect Dis 2010, 201(1):2-4.
• [4]Jaso R, Sierra M, Calleja J, Valero C, Pascual J: Guillain-Barré Syndrome after rituximab in a patient with idiopathic thombocytopenic purpura: a causal association? J Neurol 2010, 257(3):488-489.
• [5]Terenghi F, Ardolino G, Nobile-Orazio E: Guillain-Barré syndrome after combined chop and rituximab therapy in non-Hodgkin lymphoma. J Peripher Nerv Syst 2007, 12:142-143.
• [6]Tn C, Arnold D: The effect of rituximab on humoral and cell mediated immunity and infection in the treatment of autoimmune diseases. Br J Haematol 2010, 149(1):3-13.
• [7]Heikema A, Bergman M, Richards H, Crocker P, Gilbert M, Samsom J, Van Wamel W, Endtz H, Van Belkum A: Characterization of the specific interaction between Sialoadhesin and Sialylated campylobacter jejuni. Infect Immun 2010, 78(7):3237-3246.
• [8]Me L, Quan D, Ho J, Kleinscmidt D, Tyler K, Gracia T: Impact of rituximab-associated B-cell defects on West-Nile virus meningoencephalitis in solid organ transplant recipients. Clin Transplant 2010, 24:223-228.