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Case Reports in Hematology
Volume 2015 (2015), Article ID 454890, 4 pages
http://dx.doi.org/10.1155/2015/454890
Case Report

A Case of Fulminant Hepatitis due to Echovirus 9 in a Patient on Maintenance Rituximab Therapy for Follicular Lymphoma

Worthing District General Hospital, Western Sussex Hospitals NHS Foundation Trust, Lyndhurst Road, Worthing BN11 2DH, UK

Received 4 January 2015; Revised 21 April 2015; Accepted 11 May 2015

Academic Editor: Gandhi Damaj

Copyright © 2015 Ceri Morgan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Rituximab is a CD20 monoclonal antibody commonly used in the treatment of haematological malignancies. It causes lymphopenia with subsequent compromised humoral immunity resulting in an increased risk of infection. A number of infections and viral reactivations have been described as complicating Rituximab therapy. We report an apparently unique case of echovirus 9 (an enterovirus) infection causing an acute hepatitis and significant morbidity in an adult patient on maintenance treatment of Rituximab for follicular lymphoma. We also describe potential missed opportunities to employ more robust screening for viral infections which may have prevented delays in the appropriate treatment and thus may have altered the patient’s clinical course. We also make suggestions for lowering the threshold of viral testing in similar patients in the future.