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Brainstem encephalitis caused by Coxsackie A16 virus in a rituximab-immunosuppressed patient
  1. Ruaridh Cameron Smail1,
  2. John H O’Neill2 and
  3. David Andresen2
  1. 1 Neurology, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
  2. 2 Neurology, Saint Vincent’s Hospital Sydney, Darlinghurst, New South Wales, Australia
  1. Correspondence to Dr Ruaridh Cameron Smail, ruaridh.cameronsmail1{at}


Rituximab and other B cell depleting agents are increasingly used for haematological, immunological and neurological diseases. In a small minority, immunosuppression leads to increased virulence of normally mild infections. Brainstem encephalitis has been described occurring after infection from enteroviruses, more commonly in the paediatric population, but also in immunosuppressed adults. In this paper, we describe an enteroviral brainstem encephalitis in a rituximab-immunosuppressed patient. The enterovirus identified was Coxsackie A16, which has never yet been reported to cause brainstem encephalitis in an adult.

  • infection (neurology)
  • brain stem/cerebellum
  • neuro Itu
  • haematology (incl blood transfusion)

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  • Contributors All three authors cared for the patient in hospital. The case report was conceptualised and designed by RCS and JHO’N. The draft manuscript and literature review was written by RCS. The manuscript was reviewed and revised by JHO’N and DA.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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