{
  "abstract": "Introduction Enteroviruses predominantly cause self-limiting coryzal illness. However, in children and immunocompromised adults, they can cause encephalitis with serious neurological sequelae. We report a patient with enterovirus rhombencephalitis in the context of ocrelizumab treatment for multiple sclerosis.Case A 41 year old female developed sub-acute vertigo, oscillopsia and rigors whilst on holiday in Miami. In the following days, she developed a worsening dysarthria, dysphagia, and fluctuating encephalopathy.On her return to the UK, she promptly presented to her local hospital, requiring intubation for progressive bulbar dysfunction. MRI imaging highlighted a symmetrical bilateral thalamomesencephalic lesion with mild enhancement. Lumbar puncture demonstrated a lymphocytic pleocytosis, elevated protein, and negative viral panel. She was transferred to our centre, where her MS is managed, for further work-up.Following extubation, she had a severe bulbar syndrome and widespread myoclonus affecting her face and limbs followed by opsoclonus. Low level positivity for enterovirus was noted on stool and blood samples and was subsequently identified on repeat testing on CSF. She was treated with IVIG.Discussion This case highlights the utility of using ancillary investigations to detect a pathogen in work-up of meningoencephalitis, the value of repeat CSF testing and the need for strongly considering opportunistic infections in patients on B-cell depleting treatment. This is the second reported instance of enterovirus rhombencephalitis linked to ocrelizumab.amber.corrigan1@nhs.net",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, National hospital for Neurology and Neurosurgery, UCLH Foundation Trust"
      ],
      "name": "Corrigan Amber Elyse"
    },
    {
      "affiliations": [
        "Department of Neurology, National hospital for Neurology and Neurosurgery, UCLH Foundation Trust"
      ],
      "name": "Bestwick Harry"
    },
    {
      "affiliations": [
        "Department of Neurology, National hospital for Neurology and Neurosurgery, UCLH Foundation Trust"
      ],
      "name": "Baheerathan Aravindhan"
    },
    {
      "affiliations": [
        "Department of Neurology, National hospital for Neurology and Neurosurgery, UCLH Foundation Trust"
      ],
      "name": "Elsheikh Ibrahim Mai"
    },
    {
      "affiliations": [
        "University College London Hospitals NHS Foundation Trust"
      ],
      "name": "Hoskote Chandrashekar"
    },
    {
      "affiliations": [
        "University College London Hospitals NHS Foundation Trust"
      ],
      "name": "Houlihan Catherine"
    },
    {
      "affiliations": [
        "Department of Neurology, National hospital for Neurology and Neurosurgery, UCLH Foundation Trust"
      ],
      "name": "Spillane Jennifer"
    },
    {
      "affiliations": [
        "Department of Neurology, National hospital for Neurology and Neurosurgery, UCLH Foundation Trust",
        "University College London Hospitals NHS Foundation Trust",
        "Queen Square MS Centre, National Hospital for Neurology and Neurosurgery"
      ],
      "name": "Chard Declan"
    },
    {
      "affiliations": [
        "Department of Neurology, National hospital for Neurology and Neurosurgery, UCLH Foundation Trust",
        "University College London Hospitals NHS Foundation Trust",
        "Queen Square MS Centre, National Hospital for Neurology and Neurosurgery"
      ],
      "name": "Trip Anand"
    }
  ],
  "title": "87 Myoclonus in Miami",
  "uid": "bd0f61dd-3787-5d55-a792-61651dbb181b"
}