Sean Montgomery1, Joyce Jimenez Zambrano2, Scott Belliston3, Susan Scarberry4
1Neurology, University of North Dakota School of Medicine and Health Sciences, 2University of North Dakota School of Medicine and Health Sciences, 3Sanford, 4Sanford Health
Objective:
To evaluate clinical outcomes and management strategies utilized among patients treated with anti-CD20 therapies who developed West Nile Neuroinvasive Disease (WNND).
Background:
West Nile virus is associated with significant morbidity and mortality in patients who develop neuroinvasive disease. Prior literature is limited but has suggested that individuals on anti-CD20 therapies may be at increased risk for WNND, even in the absence of additional immunosuppression. As anti-CD20 therapies become increasingly accessible for patients with a variety of autoimmune conditions, it is important to further characterize the clinical presentations of WNND, identify associated risk factors, and address ongoing diagnostic and management strategies. In addition, raising awareness of this potential complication is essential in regions where West Nile virus is endemic to support early recognition and improve outcomes in this vulnerable patient population.
Results:
We describe seven patients who experienced WNND while on immunosuppressive therapy with an anti-CD20 medication. Of these patients, six had a diagnosis of relapsing-remitting multiple sclerosis (RRMS) and one had a diagnosis of myasthenia gravis (MG). All patients with RRMS had been treated with ocrelizumab at the time of symptom onset of West Nile virus infection, while the patient with MG had been treated with rituximab. All patients were female between 23-64 years old and had variable duration of disease and of anti-CD-20 therapy. All patients initially presented with fever and had CSF pleocytosis. Six were treated with intravenous immunoglobulin. Outcomes following WNND were variable among patients.
Conclusions:
This case series helps further identify and characterize different presentations of WNND in patients receiving anti-CD20 therapies and supports the importance of informed decision-making for providers caring for patients with autoimmune disorders in regions where West Nile virus is endemic. Additionally, with no current treatment protocols for WNND, it provides further data on potential treatment approaches.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.