Abstract Details

Title Neuroinvasive West Nile Virus Associated with Anti-CD20 Therapies in a University Health System

Topic Infectious Disease

Presentation(s) C19 - Monitoring Necessities for Immunotherapy Prescribers (4:31 PM-4:38 PM)
P2 - Poster Session 2 (2:45 PM-3:45 PM)

Poster/Presentation
Number 053

Background

West Nile virus (WNV) is a mosquito-borne flavivirus resulting in substantial morbidity and mortality for patients who develop neuroinvasive disease (encephalitis, meningitis, and/or myelitis). Anti-CD20 therapies are increasingly used for inflammatory diseases and malignancy, and may predispose patients to poor outcomes from WNND due to impaired humoral immunity. Diagnosis of WNND is challenging for patients on anti-CD20 therapies due to poor sensitivity of antibody testing in this population. Given the near doubling year-over-year of WNND reported by CDC ArboNET in 2023, better understanding this patient population is critical, especially as use of B-cell depleting therapies expands.

Objective

Characterize diagnostic strategies and clinical outcomes for a cohort of anti-CD20 treated patients with West Nile virus neuroinvasive disease (WNND).

Design/Methods

Retrospective chart review of patients in the UCHealth system who received anti-CD20 therapies and were diagnosed with WNND between 2008-2023.

Results

23 patients (17 women, 6 men) were included with mean age 56 years (range 27-86 years). Indications for anti-CD20 therapy included multiple sclerosis (13), rheumatological disease (5), malignancy (3), anti-NMDAR encephalitis (1), and transplant rejection (1); mean duration of treatment was 45.4 months (range 1-127 months). All patients presented with meningoencephalitis. For patients with available data, 8/19 had hypogammaglobulinemia while 17/17 had CD19+ depletion. While CSF WNV-IgM was positive in only 3/20 tested patients, CSF WNV-RT-PCR was positive in 13/14. The remaining patients were identified based on serum WNV-IgM and RT-PCR testing. 11/24 patients were treated with IVIG. 8/24 patients required intubation and 4/24 died. 19/24 patients had decline in modified Rankin Scale (mRS) 90 days from discharge compared to baseline, with median mRS pre-WNND 1 (range 0-3) and post-WNND 3 (range 1-6).

Conclusions

Descriptions of WNND in the setting of anti-CD20 treatment remain limited. This cohort emphasizes the importance of diagnostic CSF RT-PCR and need for targeted therapies given considerable morbidity and mortality.

Authors/Disclosures
Rumyar V. Ardakani, MD (Neuro-Infectious Diseases Group) PRESENTER	Dr. Ardakani has nothing to disclose.
Paul D. Crane, MD (University of Colorado)	Dr. Crane has nothing to disclose.
Enrique Alvarez, MD, PhD (University of Colorado)	Dr. Alvarez has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Alvarez has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Alvarez has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celgene/BMS. The institution of an immediate family member of Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon.
Lakshmi Chauhan, MD (University of Colorado)	The institution of Dr. Chauhan has received research support from NIH. The institution of an immediate family member of Dr. Chauhan has received research support from University of Colorado.
Elizabeth Matthews, MD	Dr. Matthews has nothing to disclose.
Anna Shah, MD (University of Colorado, Neurology Dept)	The institution of Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. The institution of Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. The institution of Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. The institution of Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. The institution of Dr. Shah has received research support from Genentech/Roche. Dr. Shah has received personal compensation in the range of $5,000-$9,999 for serving as a Educational Speaker with Rocky Mountain MS Center.
Daniel Pastula, MD, MHS, FAAN (University of Colorado, Department of Neurology)	Dr. Pastula has nothing to disclose.
Kelli Money, MD, PhD (UCHealth Neurology Clinic- Memorial Hospital North)	Dr. Money has nothing to disclose.
Amanda L. Piquet, MD, FAAN (University of Colorado)	The institution of Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. The institution of Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. The institution of Dr. Piquet has received personal compensation in the range of $0-$499 for serving as a Consultant for UCB. The institution of Dr. Piquet has received personal compensation in the range of $0-$499 for serving as a Consultant for EMD Serono. Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. The institution of Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kyverna. Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Sands Anderson PC. Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Joe Jones Law Firm. The institution of Dr. Piquet has received research support from Rocky Mountain MS Center. The institution of Dr. Piquet has received research support from Novartis. The institution of Dr. Piquet has received research support from Abbvie. The institution of Dr. Piquet has received research support from Roche/Genentech. The institution of Dr. Piquet has received research support from NYU. The institution of Dr. Piquet has received research support from Anokion. The institution of Dr. Piquet has received research support from UCB . The institution of Dr. Piquet has received research support from Foundation for Sarcoidosis. Dr. Piquet has received publishing royalties from a publication relating to health care. Dr. Piquet has received publishing royalties from a publication relating to health care. Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving as a Litigative Consultant with US-Dept HHS/DICP. Dr. Piquet has a non-compensated relationship as a Medical Advisory Board Member with Autoimmune Encephalitis Alliance (AEA) that is relevant to AAN interests or activities. Dr. Piquet has a non-compensated relationship as a Medical Advisory Board Member with Stiff Person Syndrome Research Foundation (SPSRF) that is relevant to AAN interests or activities.
Kenneth L. Tyler, MD, FAAN (University of Colorado School of Medicine)	Dr. Tyler has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Protagonist Therapeutics, Newark CA. Dr. Tyler has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Neurological Association/Wiley. Dr. Tyler has received intellectual property interests from a discovery or technology relating to health care. Dr. Tyler has received publishing royalties from a publication relating to health care. Dr. Tyler has a non-compensated relationship as a Director (ex officio) with American Neurological association that is relevant to AAN interests or activities. Dr. Tyler has a non-compensated relationship as a Director with International Society for Neurovirology that is relevant to AAN interests or activities.
Andrew Wolf, MD	The institution of Dr. Wolf has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. The institution of Dr. Wolf has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. The institution of Dr. Wolf has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. The institution of Dr. Wolf has received research support from Genentech. The institution of Dr. Wolf has received research support from Rocky Mountain MS Center. The institution of Dr. Wolf has received research support from Michael J. Fox Foundation. Dr. Wolf has received publishing royalties from a publication relating to health care.