Poster Display Therapy

MANAGEMENT OF ENTEROVIRUS ENCEPHALITIS IN AGAMMAGLOBULINEMIA: A CASE SERIES

Lecture Time
10:45 - 10:46
Presenter
  • Ambreen A. Pandrowala, India
Room
Poster Area
Date
20.09.2019, Friday
Session Time
10:00 - 17:00
Board Number
195
Presentation Topic
Therapy

Abstract

Background and Aims

Enterovirus encephalitis has been described in patients with agammaglobulinemia since 1961.It can occur even with adequate immunoglobulin replacement as there can be great variation in antibody titres against circulating enterovirus serotypes.Lack of specific therapy and delay in diagnosis contribute to the poor outcome. We present two patients managed at our centre in collaboration with Great Ormond Street Hospital with near complete recovery.

Aims- Retrospective analysis of clinical manifestations, management and outcome in two agammaglobulinemic patients diagnosed with enterovirus encephalitis.

Methods

2 patients from 2 different families with enterovirus encephalitis while on immunoglobulin replacement therapy were retrospectively analysed.

Results

Patient 1- 3 ½ year old girl on ivig for agammaglobulinemia developed subacute onset of drowsiness.CSF showed pleocytosis, enterovirus detected by PCR and MRI was suggestive of meningoencephalitis.She had persistence of enterovirus in CSF, developed status epilepticus 6 months later with rapid neurological deterioration. A trial of ribavirin and fluoxetine with high dose ivig resulted in clinical improvement within a month.She regained most of her milestones with improvement in MRI changes and CSF pleocytosis but developed orthostatic tremors during a year of follow up.Patient 2- 5 year old boy diagnosed as XLA, on immunoglobulin replacement therapy presented with acute onset encephalopathy with CSF pleocytosis and enterovirus detected by PCR.He was started on fluoxetine and ivig at first presentation.Within 3 months of treatment all symptoms had resolved except left arm paresis.

Conclusions

Fluoxetine and ribavirin have antiviral activity against enterovirus and are easily available. Early treatment with high dose ivig and antivirals may have better outcomes.

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