RT Journal Article SR Electronic T1 Balancing immunosuppression and infection: recurrent enterovirus encephalitis in SLE JF Practical Neurology JO Pract Neurol FD BMJ Publishing Group Ltd SP 508 OP 510 DO 10.1136/practneurol-2019-002229 VO 19 IS 6 A1 Sanjay Cheema A1 Eva Bunting A1 Catriona Good A1 Vijay Hajela A1 Basil H Ridha A1 Romi Anirban Saha YR 2019 UL http://pn.bmj.com/content/19/6/508.abstract AB 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.