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This diagnosis was retained in the face of a prolonged fever, sicca syndrome, hepatic damage and renal pseudotumour associated to a high level of IGg4 at 2.8\u00a0g\/L with suggestive renal histology. The patient was treated with corticosteroid therapy with persistence of renal impairment and nephrotic syndrome indicating RTX therapy. The patient received his first dose of RTX and presented neurological and respiratory impairments a few hours afterwards. An infectious investigation comprising a SARS CoV\u20102 PCR and viral PCRs (VZV, herpes and CMV) on cerebrospinal fluid (CSF) were negative. The HBV, HCV, HIV, Parvo B19, CMV, EBV, herpes, mycoplasma and syphilis serologies as well as <jats:italic>Legionella antigenuria<\/jats:italic> were also negative. The patient had received intravenous immunoglobulins (IVIG) and methylprednisone, associated with sodium valproate with favourable outcome. The diagnosis of MERS induced by RTX was retained in our patient according to clinical and radiological features. We herein report the first case of MERS following RTX in a patient treated for IgG4\u2010RD.<\/jats:p>","DOI":"10.1111\/bcp.15189","type":"journal-article","created":{"date-parts":[[2021,12,18]],"date-time":"2021-12-18T08:08:34Z","timestamp":1639814914000},"page":"2969-2972","source":"Crossref","is-referenced-by-count":4,"title":["Rituximab\u2010induced mild encephalopathy with a reversible splenial lesion syndrome (MERS): An adverse effect to add to the list"],"prefix":"10.1111","volume":"88","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4830-3794","authenticated-orcid":false,"given":"Maissa","family":"Thabet","sequence":"first","affiliation":[{"name":"Internal Medicine Department Farhat Hached University Hospital  Sousse Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amira","family":"Atig","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Farhat Hached University Hospital  Sousse 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