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Fatal Enterovirus-related Myocarditis in a Patient with Devic’s Syndrome Treated with Rituximab

2021; Volume: 7; Linguagem: Inglês

10.15420/cfr.2020.33

2057-7559

Ava Diarra, Guillaume Gantois, Mouna Lazrek, Basile Verdier, Vincent Elsermans, Hélène Zéphir, Benjamin Longère, Xristos Gkizas, Céline Goéminne, Gilles Lemesle, Françis Juthier, Johana Béné, David Launay, Romain Dubois, S. Morell‐Dubois, Fanny Vuotto, Anne-Laure Piton,

Immunodeficiency and Autoimmune Disorders

Enteroviruses are a frequent source of infection and among the most common central nervous system viral pathogens. Enteroviruses – in particular, the Coxsackie B viruses – are a known cause of myocarditis. Rituximab is a genetically engineered chimeric anti-CD20 monoclonal antibody. Many reports in the literature suggest a higher risk of infection following repeated rituximab therapy, including viral infection. However, observations of enterovirus-related myocarditis in the context of rituximab treatment are scarce. The authors describe the case of a patient with neuromyelitis optica spectrum disorder who developed severe and fatal enterovirus-related myocarditis after rituximab therapy with a difficult differential diagnosis of autoimmune or giant-cell myocarditis. This case highlights the importance of complete diagnostic workup in difficult cases of myocarditis, including endomyocardial biopsies.