Two Cases of Severe Tick-Borne Encephalitis in Rituximab-Treated Patients in Germany: Implications for Diagnosis and Prevention

Philipp A Steininger; Tobias Bobinger; Wenke Dietrich; De-Hyung Lee; Michael Knott; Christian Bogdan; Klaus Korn; Roland Lang

doi:10.1093/ofid/ofx204

Two Cases of Severe Tick-Borne Encephalitis in Rituximab-Treated Patients in Germany: Implications for Diagnosis and Prevention

Open Forum Infect Dis. 2017 Sep 26;4(4):ofx204. doi: 10.1093/ofid/ofx204. eCollection 2017 Fall.

Authors

Philipp A Steininger¹, Tobias Bobinger², Wenke Dietrich³, De-Hyung Lee², Michael Knott⁴, Christian Bogdan⁵, Klaus Korn¹, Roland Lang⁵

Affiliations

¹ Institute of Clinical and Molecular Virology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
² Department of Neurology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
³ Department of Neurology, Nuremberg Hospital South, Paracelsus Medizinische Privatuniversität (PMU), Nürnberg, Germany.
⁴ Department of Neuroradiology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
⁵ Institute of Clinical Microbiology, Immunology and Hygiene, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.

Abstract

Rituximab (RTX) has become a standard therapy for certain B cell malignancies and autoimmune diseases. We report 2 RTX-treated patients who developed severe tick-borne encephalitis virus (TBEV) infection. The inability to generate new antibody responses renders RTX-treated patients susceptible to TBEV, impedes laboratory diagnosis, and necessitates preventive vaccination in endemic areas.

Keywords: B cell depletion; immunoglobulins; tick-borne encephalitis; vaccination.

Publication types

Case Reports