Balancing immunosuppression and infection: recurrent enterovirus encephalitis in SLE. Issue 6 (6th June 2019)

• Record Type: Journal Article
• Authors: Cheema, Sanjay; Bunting, Eva; Good, Catriona; Hajela, Vijay; Ridha, Basil H; Saha, Romi Anirban
• Is Part Of: Practical neurology. Volume 19:Issue 6(2019)
• Page Start: 508
• Page End: 510
• Publication Date: 2019-06-06
• Subjects: neurovirology -- SLE -- encephalitis -- infectious diseases; Neurology -- Periodicals; 616.8005
• DOI: 10.1136/practneurol-2019-002229
• Languages: English
• ISSNs: 1474-7758

Abstract

Abstract : A young woman with systemic lupus erythematosus (SLE) developed recurrent enterovirus meningoencephalitis while taking prednisolone, azathioprine and rituximab. After reducing the immunosuppression, she developed a central nervous system (CNS) flare of SLE, with enterovirus still present in the cerebrospinal fluid (CSF). There are no evidence-based specific treatments for enterovirus encephalitis, but she responded well to intravenous immunoglobulin alongside pulsed methylprednisolone and rituximab. This case highlights the difficulties in managing people with co-existing infective and autoimmune conditions, especially if each affects the CNS. A viral infection and SLE flare can resemble one another clinically, although here the radiological differentiation of CNS lupus versus enterovirus encephalitis helped to guide the diagnosis.