Maillet F, Pineton De Chambrun M, Monzani Q, Mercy G, Schuffenecker I, Mirand A, Deback C, Charlotte F, Fourniols E, Mathian A, Amoura Z
Service de médecine interne 2, institut E3M, Sorbonne université, hôpital La Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris (AP-HP), 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Service de médecine interne 2, institut E3M, Sorbonne université, hôpital La Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris (AP-HP), 47-83, boulevard de l'Hôpital, 75013 Paris, France; Service de médecine intensive-réanimation, institut de cardiologie, Sorbonne université, hôpital La Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Rev Med Interne. 2020 Mar;41(3):200-205. doi: 10.1016/j.revmed.2019.12.018. Epub 2020 Jan 21.
Chronic enterovirus infections can occur in primary immunodeficiency with hypogammaglobulinemia. They usually associate meningitis and myofasciitis. Such infections have also been described in adults with rituximab-induced hypogammaglobulinemia.
We report the case of a 33-year-old woman who was given rituximab for immune thrombocytopenia and developed rituximab-induced hypogammaglobulinemia (IgG 4.4g/L). One year after the last rituximab infusion, she developed lower limbs myofasciitis, followed two months later by a chronic lymphocytic meningitis. PCR in the serum and the cerebrospinal fluid at the time of the meningitis and the myofasciitis were positive to the same enterovirus (echovirus 11) while it was negative in the fascia biopsy. Under treatment with intravenous immunoglobulins, all symptoms and laboratory abnormalities improved and enterovirus PCR became negative.
We report a case of chronic enterovirus infection associating meningitis and myofasciitis in an adult with rituximab-induced hypogammaglobulinemia. Outcome was favorable under treatment with intravenous immunoglobulins.
慢性肠道病毒感染可发生于伴有低丙种球蛋白血症的原发性免疫缺陷病中。它们通常与脑膜炎和肌筋膜炎相关。此类感染在接受利妥昔单抗治疗导致低丙种球蛋白血症的成人中也有报道。
我们报告一例33岁女性病例，该患者因免疫性血小板减少症接受利妥昔单抗治疗，并出现利妥昔单抗诱导的低丙种球蛋白血症（IgG 4.4g/L）。在最后一次输注利妥昔单抗一年后，她出现下肢肌筋膜炎，两个月后继而出现慢性淋巴细胞性脑膜炎。脑膜炎和肌筋膜炎发作时血清及脑脊液的聚合酶链反应（PCR）检测对同一种肠道病毒（埃可病毒11型）呈阳性，而筋膜活检结果为阴性。在接受静脉注射免疫球蛋白治疗后，所有症状及实验室异常情况均有所改善，肠道病毒PCR检测结果转为阴性。
我们报告一例成人患者，其因利妥昔单抗诱导的低丙种球蛋白血症并发慢性肠道病毒感染，伴有脑膜炎和肌筋膜炎。静脉注射免疫球蛋白治疗后预后良好。
