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Severe Neuroinvasive West Nile Virus in Association With Anti-CD20 Monotherapy for Multiple Sclerosis
OBJECTIVES: The objective of this study was to report on the development of neuroinvasive West Nile virus (WNV) infection in the context of anti-CD20 monotherapy for multiple sclerosis (MS). METHODS: This is a case series study. RESULTS: In 2021–2022, we observed 4 cases of neuroinvasive WNV infecti...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10414775/ https://www.ncbi.nlm.nih.gov/pubmed/37562975 http://dx.doi.org/10.1212/NXI.0000000000200154 |
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author | Thebault, Simon Gandelman, Stephanie Lane, Camryn Kim, Erin J. Pileggi, Caitlin Zuroff, Leah Yamashita, Luana D. Schindler, Matthew K. Chiu, Charles Wilson, Michael R. Berger, Joseph R. Markowitz, Clyde Bar-Or, Amit Fuller, Ryan Brandstadter, Rachel Pruitt, Amy A. Jacobs, Dina A. |
author_facet | Thebault, Simon Gandelman, Stephanie Lane, Camryn Kim, Erin J. Pileggi, Caitlin Zuroff, Leah Yamashita, Luana D. Schindler, Matthew K. Chiu, Charles Wilson, Michael R. Berger, Joseph R. Markowitz, Clyde Bar-Or, Amit Fuller, Ryan Brandstadter, Rachel Pruitt, Amy A. Jacobs, Dina A. |
author_sort | Thebault, Simon |
collection | PubMed |
description | OBJECTIVES: The objective of this study was to report on the development of neuroinvasive West Nile virus (WNV) infection in the context of anti-CD20 monotherapy for multiple sclerosis (MS). METHODS: This is a case series study. RESULTS: In 2021–2022, we observed 4 cases of neuroinvasive WNV infection in our patient population of 2009 patients with MS on ocrelizumab, compared with a total of 46 cases of neuroinvasive WNV infection reported in Pennsylvania and 40 in New Jersey. Odds were 258 times that of the general population (95% confidence interval 97–691), χ(2) p < 0.0001). All were women aged 41–61 years with variable disease duration, level of disability, and duration of anti-CD20 therapy. All presented in summer/early fall with fever, headache, and encephalopathy consistent with meningoencephalitis. Three patients had acute cerebellitis. Two had anterior nerve root involvement progressing to quadriparesis, and 1 developed refractory nonconvulsive status epilepticus. All required intubation and experienced significant morbidity. All had CSF pleocytosis. Two patients were WNV IgM positive in both the serum and CSF, 1 patient had positive serum IgM and CSF metagenomic next-generation sequencing (mNGS), while 1 had positive CSF mNGS with negative serum and CSF antibodies. DISCUSSION: Neuroinvasive WNV infection can develop with anti-CD20 monotherapy in the absence of additional immunosuppression. WNV serologies may be negative in the setting of anti-CD20 treatment; in the appropriate clinical context, one should consider direct detection methods such as PCR or mNGS-based testing. |
format | Online Article Text |
id | pubmed-10414775 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-104147752023-08-11 Severe Neuroinvasive West Nile Virus in Association With Anti-CD20 Monotherapy for Multiple Sclerosis Thebault, Simon Gandelman, Stephanie Lane, Camryn Kim, Erin J. Pileggi, Caitlin Zuroff, Leah Yamashita, Luana D. Schindler, Matthew K. Chiu, Charles Wilson, Michael R. Berger, Joseph R. Markowitz, Clyde Bar-Or, Amit Fuller, Ryan Brandstadter, Rachel Pruitt, Amy A. Jacobs, Dina A. Neurol Neuroimmunol Neuroinflamm Clinical/Scientific Note OBJECTIVES: The objective of this study was to report on the development of neuroinvasive West Nile virus (WNV) infection in the context of anti-CD20 monotherapy for multiple sclerosis (MS). METHODS: This is a case series study. RESULTS: In 2021–2022, we observed 4 cases of neuroinvasive WNV infection in our patient population of 2009 patients with MS on ocrelizumab, compared with a total of 46 cases of neuroinvasive WNV infection reported in Pennsylvania and 40 in New Jersey. Odds were 258 times that of the general population (95% confidence interval 97–691), χ(2) p < 0.0001). All were women aged 41–61 years with variable disease duration, level of disability, and duration of anti-CD20 therapy. All presented in summer/early fall with fever, headache, and encephalopathy consistent with meningoencephalitis. Three patients had acute cerebellitis. Two had anterior nerve root involvement progressing to quadriparesis, and 1 developed refractory nonconvulsive status epilepticus. All required intubation and experienced significant morbidity. All had CSF pleocytosis. Two patients were WNV IgM positive in both the serum and CSF, 1 patient had positive serum IgM and CSF metagenomic next-generation sequencing (mNGS), while 1 had positive CSF mNGS with negative serum and CSF antibodies. DISCUSSION: Neuroinvasive WNV infection can develop with anti-CD20 monotherapy in the absence of additional immunosuppression. WNV serologies may be negative in the setting of anti-CD20 treatment; in the appropriate clinical context, one should consider direct detection methods such as PCR or mNGS-based testing. Lippincott Williams & Wilkins 2023-08-10 /pmc/articles/PMC10414775/ /pubmed/37562975 http://dx.doi.org/10.1212/NXI.0000000000200154 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Clinical/Scientific Note Thebault, Simon Gandelman, Stephanie Lane, Camryn Kim, Erin J. Pileggi, Caitlin Zuroff, Leah Yamashita, Luana D. Schindler, Matthew K. Chiu, Charles Wilson, Michael R. Berger, Joseph R. Markowitz, Clyde Bar-Or, Amit Fuller, Ryan Brandstadter, Rachel Pruitt, Amy A. Jacobs, Dina A. Severe Neuroinvasive West Nile Virus in Association With Anti-CD20 Monotherapy for Multiple Sclerosis |
title | Severe Neuroinvasive West Nile Virus in Association With Anti-CD20 Monotherapy for Multiple Sclerosis |
title_full | Severe Neuroinvasive West Nile Virus in Association With Anti-CD20 Monotherapy for Multiple Sclerosis |
title_fullStr | Severe Neuroinvasive West Nile Virus in Association With Anti-CD20 Monotherapy for Multiple Sclerosis |
title_full_unstemmed | Severe Neuroinvasive West Nile Virus in Association With Anti-CD20 Monotherapy for Multiple Sclerosis |
title_short | Severe Neuroinvasive West Nile Virus in Association With Anti-CD20 Monotherapy for Multiple Sclerosis |
title_sort | severe neuroinvasive west nile virus in association with anti-cd20 monotherapy for multiple sclerosis |
topic | Clinical/Scientific Note |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10414775/ https://www.ncbi.nlm.nih.gov/pubmed/37562975 http://dx.doi.org/10.1212/NXI.0000000000200154 |
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