Antiviral treatment with fluoxetine for rituximab-associated chronic echovirus 13 meningoencephalitis and myofasciitis
Vermeersch, Gaël; Laenen, Lies; Lens, Géraldine; van der Elst, Kim C M; Thal, Dietmar Rudolf; Jentjens, Sander; Demaerel, Philippe; Van Nieuwenhuyse, Tine; Wollants, Elke; Boeckx, Nancy; Verhaert, Nicolas; Dubois, Benedicte; Kuppeveld, Frank J M; Woei-A-Jin, F J Sherida H
(2022) European Journal of Neurology, volume 29, issue 10, pp. 3117 - 3123
(Article)
Abstract
BACKGROUND AND PURPOSE: Enterovirus infections pose a serious threat for patients with humoral deficiencies and may be lethal, whilst the efficacy of proposed treatment options such as corticosteroids, intravenous immunoglobulins and fluoxetine remains debated. METHODS: Viral clearance was investigated in a patient with rituximab-induced B-cell depletion and chronic echovirus 13
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(E13) meningoencephalitis/myofasciitis in response to intravenous immunoglobulins and fluoxetine using sequential semi-quantitative E13 viral load measurements by real-time reverse transcription polymerase chain reaction. Fluoxetine concentrations in plasma and cerebrospinal fluid were determined by liquid chromatography mass spectrometry. RESULTS: Intravenous immunoglobulins appeared ineffective in this case of E13 infection, whereas virus clearance in cerebrospinal fluid was obtained after 167 days of oral fluoxetine. Since treatment with corticosteroids resulted in a flare of symptoms, rechallenge with viral load measurements was not attempted. CONCLUSION: In this report of a patient with rituximab-associated chronic echovirus 13 meningoencephalitis, viral clearance in response to single treatment options is assessed for the first time. Our observations further support the in vivo efficacy of fluoxetine against enteroviral infections. More research is needed to establish its efficacy in different enterovirus strains.
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Keywords: enterovirus, fluoxetine, hypogammaglobulinaemia, intravenous immunoglobulins, meningoencephalitis, Clinical Neurology, Neurology
ISSN: 1351-5101
Publisher: Wiley-Blackwell
Note: Funding Information: The patient is thanked for her permission to publish this report, Leslie Princen and Nele Van den Eede for their assistance in the collection and processing of plasma and CSF samples, and the colleagues from the Centre for Human Genetics for their valuable scientific input and elaborate discussions. The authors explicitly wish to acknowledge Mandy Bloemen for her extensive laboratory work, and the role Sarah Bonnewijn and Friedl Sinnaeve played on crucial moments of this study. Finally, Marc Van Ranst and Nele Van den Eede are thanked for their support in research data validation. This study was not financially supported. Publisher Copyright: © 2022 European Academy of Neurology.
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