Neurology. Clinical practice · 2025
West Nile Virus Neuroinvasive Disease in Patients Treated With Anti-CD20 Therapies.
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Ardakani Rumyar V, Crane Paul Daniel, Pastula Daniel M, Chauhan Lakshmi, Matthews Elizabeth, Money Kelli M, Shah Anna, Piquet Amanda L, Gross Robert H, Carlson Aaron M, Tyler Kenneth L, Corboy John R, Alvarez Enrique, Wolf Andrew B
Аннотация
BACKGROUND AND OBJECTIVES: The literature on severe West Nile virus (WNV) neuroinvasive disease (WNND) in patients treated with anti-CD20 therapies is limited. We systematically characterize cases of WNND in the tertiary academic UCHealth system.
METHODS: A retrospective cohort (January 2016 to January 2024) of patients with a validated diagnosis of WNND and anti-CD20 medication use was identified with electronic medical record query followed by individual chart review.
RESULTS: We identified 25 patients; multiple sclerosis was the most common indication for anti-CD20 therapy in 13 patients (52%). Twenty-one patients (84%) presented with meningoencephalitis. CSF WNV IgM was positive in 5 of 21 patients (24%) who were tested while 13 of 14 tested patients (93%) had positive reverse-transcription PCR (RT-PCR) findings in the CSF. MRI demonstrated anomalies associated with WNND in 12 of 23 patients (52%) with available imaging. Intensive care unit admission was required in 8 patients (32%), and 12 patients (48%) were treated with intravenous immunoglobulin. Worsening of ≥1 point from pre-WNV baseline modified Rankin Scale (mRS) score to the 90-day postdischarge mRS score was seen in 18 patients (75%). Two patients (8%) died by 90 days.
DISCUSSION: WNND leads to disability accrual in patients on B cell-depleting anti-CD20 therapies. Utilization of RT-PCR is important in optimizing diagnosis in this patient population because of limited sensitivity of the WNV-IgM testing commonly used in the general population.
METHODS: A retrospective cohort (January 2016 to January 2024) of patients with a validated diagnosis of WNND and anti-CD20 medication use was identified with electronic medical record query followed by individual chart review.
RESULTS: We identified 25 patients; multiple sclerosis was the most common indication for anti-CD20 therapy in 13 patients (52%). Twenty-one patients (84%) presented with meningoencephalitis. CSF WNV IgM was positive in 5 of 21 patients (24%) who were tested while 13 of 14 tested patients (93%) had positive reverse-transcription PCR (RT-PCR) findings in the CSF. MRI demonstrated anomalies associated with WNND in 12 of 23 patients (52%) with available imaging. Intensive care unit admission was required in 8 patients (32%), and 12 patients (48%) were treated with intravenous immunoglobulin. Worsening of ≥1 point from pre-WNV baseline modified Rankin Scale (mRS) score to the 90-day postdischarge mRS score was seen in 18 patients (75%). Two patients (8%) died by 90 days.
DISCUSSION: WNND leads to disability accrual in patients on B cell-depleting anti-CD20 therapies. Utilization of RT-PCR is important in optimizing diagnosis in this patient population because of limited sensitivity of the WNV-IgM testing commonly used in the general population.