Fatal Enterovirus-related Myocarditis in a Patient with Devic’s Syndrome Treated with Rituximab

• Main Authors: Ava Diarra, Guillaume Gantois, Mouna Lazrek, Basile Verdier, Vincent Elsermans, Hélène Zephir, Benjamin Longère, Xristos Gkizas, Céline Goeminne, Gilles Lemesle, Francis Juthier, Johana Bene, David Launay, Romain Dubois, Sandrine Morell-Dubois, Fanny Vuotto, Anne-Laure Piton
• Format: Article
• Language: English
• Published: Radcliffe Medical Media 2021-05-01
• Series: Cardiac Failure Review
• Online Access: https://www.cfrjournal.com/articleindex/cfr.2020.33
• ISSN: 2057-7540; 2057-7559

Enteroviruses are a frequent source of infection and among the most common central nervous system viral pathogens. Enteroviruses – in particular, the Coxsackie B viruses – are a known cause of myocarditis. Rituximab is a genetically engineered chimeric anti-CD20 monoclonal antibody. Many reports in the literature suggest a higher risk of infection following repeated rituximab therapy, including viral infection. However, observations of enterovirus-related myocarditis in the context of rituximab treatment are scarce. The authors describe the case of a patient with neuromyelitis optica spectrum disorder who developed severe and fatal enterovirus-related myocarditis after rituximab therapy with a difficult differential diagnosis of autoimmune or giant-cell myocarditis. This case highlights the importance of complete diagnostic workup in difficult cases of myocarditis, including endomyocardial biopsies.