Abstract Details

Title Anti-CD20 Therapies Associated With Severe West Nile Neuroinvasive Disease

Topic Infectious Disease

Presentation(s) P11 - Poster Session 11 (11:45 AM-12:45 PM)

Poster/Presentation
Number 3-012

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.

Design/Methods NA

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.

Authors/Disclosures
Sean Montgomery, MD PRESENTER	Dr. Montgomery has nothing to disclose.
Joyce A. Jimenez Zambrano, MD	Dr. Jimenez Zambrano has nothing to disclose.
Scott M. Belliston, DO (Sanford)	Dr. Belliston has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech.
Susan L. Scarberry, MD, FAAN (Sanford Health)	Dr. Scarberry has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Scarberry has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Greenwich. Dr. Scarberry has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Argenix. Dr. Scarberry has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD Serono. The institution of Dr. Scarberry has received research support from Sanofi Genzyme.

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