{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:01:15Z","timestamp":1785484875142,"version":"3.56.0"},"reference-count":62,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Multiple Sclerosis Journal \u2013 Experimental, Translational and Clinical"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>B-cell depleting therapies are used for MS, autoimmune disorders, renal disease and hematological malignancies but increase infection susceptibility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe two cases of enterovirus meningoencephalitis in patients receiving B-cell depleting therapy and review anti-CD20-associated cases, detailing diagnosis, treatment, and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We present two cases, one with MS and one with minimal change disease, and review 40 additional anti-CD20 cases. Demographic, clinical, laboratory, neuroimaging, treatment, and outcomes were abstracted. Neuro-QoL measures were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our cases were diagnosed by CSF multiplex PCR and treated with IVIg; one also received methylprednisolone and pocapavir. Persistent sequelae included dysarthria, cognitive impairment, nystagmus, pain, and reduced Neuro-QoL scores. Of 42 cases, 34 were associated with rituximab and eight with ocrelizumab. CSF PCR or molecular testing detected enterovirus in 39 cases; three required alternative specimens\/sites. IVIg or subcutaneous immunoglobulin (SCIg) was used in 36 cases, steroids in seven, fluoxetine in six, pocapavir in two, pleconaril in two, and ribavirin\/favipiravir in one. Outcomes included recovery in 11, sequelae in 19, and death in 12.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Enterovirus infection in B-cell depleted patients may cause severe CNS involvement. CSF PCR aids diagnosis, though alternative specimens may be required. Early IVIg and investigational antivirals may be considered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20552173261471722","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:02:01Z","timestamp":1785247321000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Anti-CD20 associated enterovirus meningoencephalitis: A narrative review with two illustrative cases"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0339-9876","authenticated-orcid":false,"given":"Kedar R","family":"Mahajan","sequence":"first","affiliation":[{"name":"Neurologic Institute, Cleveland Clinic"},{"name":"Department of Neurosciences, Cleveland Clinic Research, Cleveland Clinic, Cleveland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Bittner","sequence":"additional","affiliation":[{"name":"Neurologic Institute, Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7950-7602","authenticated-orcid":false,"given":"Mary Alissa","family":"Willis","sequence":"additional","affiliation":[{"name":"Neurologic Institute, Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Isada","sequence":"additional","affiliation":[{"name":"Integrated Hospital Care Institute, Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2334-6883","authenticated-orcid":false,"given":"Robert","family":"Bermel","sequence":"additional","affiliation":[{"name":"Neurologic Institute, Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4263-3717","authenticated-orcid":false,"given":"Robert J","family":"Fox","sequence":"additional","affiliation":[{"name":"Neurologic Institute, Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Lee","sequence":"additional","affiliation":[{"name":"Imaging Institute, Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Kunchok","sequence":"additional","affiliation":[{"name":"Neurologic Institute, Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix319"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00705-020-04891-1"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000200534"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2023-004036"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/13524585251322327"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2011.03.009"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-021-06956-1"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.41.10.4605-4610.2003"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2019-230177"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000213585"},{"key":"e_1_3_2_12_2","article-title":"Enteroviral meningoencephalitis as a complication of rituximab therapy for rheumatoid arthritis","volume":"13","author":"Cook SG","year":"2021","unstructured":"Cook SG, Ford AW, Lindholm DA, et al. 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