TY - JOUR T1 - Balancing immunosuppression and infection: recurrent enterovirus encephalitis in SLE JF - Practical Neurology JO - Pract Neurol SP - 508 LP - 510 DO - 10.1136/practneurol-2019-002229 VL - 19 IS - 6 AU - Sanjay Cheema AU - Eva Bunting AU - Catriona Good AU - Vijay Hajela AU - Basil H Ridha AU - Romi Anirban Saha Y1 - 2019/12/01 UR - http://pn.bmj.com/content/19/6/508.abstract N2 - 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. ER -