{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T02:23:52Z","timestamp":1785291832900,"version":"3.55.0"},"reference-count":2,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2019,5,25]]},"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:p>A young woman with systemic lupus erythematosus (SLE) developed recurrent enterovirus meningoencephalitis while taking prednisolone, azathioprine and rituximab. After reducing the immunosuppression, she developed a central nervous system (CNS) flare of SLE, with enterovirus still present in the cerebrospinal fluid (CSF). There are no evidence-based specific treatments for enterovirus encephalitis, but she responded well to intravenous immunoglobulin alongside pulsed methylprednisolone and rituximab. This case highlights the difficulties in managing people with co-existing infective and autoimmune conditions, especially if each affects the CNS. A viral infection and SLE flare can resemble one another clinically, although here the radiological differentiation of CNS lupus versus enterovirus encephalitis helped to guide the diagnosis.<\/jats:p>","DOI":"10.1136\/practneurol-2019-002229","type":"journal-article","created":{"date-parts":[[2019,6,6]],"date-time":"2019-06-06T17:15:31Z","timestamp":1559841331000},"page":"508-510","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Balancing immunosuppression and infection: recurrent enterovirus encephalitis in SLE"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5438-6549","authenticated-orcid":false,"given":"Sanjay","family":"Cheema","sequence":"first","affiliation":[{"name":"Neurology, Brighton and Sussex University Hospitals NHS Trust, Haywards Heath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Bunting","sequence":"additional","affiliation":[{"name":"Neurology, National Hospital for Neurology and Neurosurgery, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catriona","family":"Good","sequence":"additional","affiliation":[{"name":"Neuroradiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay","family":"Hajela","sequence":"additional","affiliation":[{"name":"Rheumatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basil H","family":"Ridha","sequence":"additional","affiliation":[{"name":"Neurology, Brighton and Sussex University Hospitals NHS Trust, Haywards Heath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romi Anirban","family":"Saha","sequence":"additional","affiliation":[{"name":"Neurology, Brighton and Sussex University Hospitals NHS Trust, Haywards Heath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,6,6]]},"reference":[{"key":"2025090409403601000_19.6.508.1","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1002\/hon.2365","article-title":"Enteroviral infection in patients treated with rituximab for non-Hodgkin lymphoma: a case series and review of the literature","volume":"35","author":"Grisariu","year":"2017","journal-title":"Hematol Oncol"},{"key":"2025090409403601000_19.6.508.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2006.05.009"}],"container-title":["Practical Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/practneurol-2019-002229","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T16:40:42Z","timestamp":1757004042000},"score":1,"resource":{"primary":{"URL":"https:\/\/pn.bmj.com\/lookup\/doi\/10.1136\/practneurol-2019-002229"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,6]]},"references-count":2,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,11,15]]},"published-print":{"date-parts":[[2019,12]]}},"alternative-id":["10.1136\/practneurol-2019-002229"],"URL":"https:\/\/doi.org\/10.1136\/practneurol-2019-002229","relation":{},"ISSN":["1474-7758","1474-7766"],"issn-type":[{"value":"1474-7758","type":"print"},{"value":"1474-7766","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,6]]}}}