Livestock-associated Staphylococcus aureus in Childcare Worker

rituximab or other immunosuppressive treatments should be prescribed cautiously; the possibility for rare complications should be recognized. Because of massive ablation of humoral immunity, the relationship between rituximab and virus infection has been addressed, including varicella–zoster infection, parvovirus B19 infection, and CMV reactivation (7). In immunocompromised patients, rituximab might lead to higher risk for virus infection. This issue has been addressed with HIV/AIDS patients with high-grade B-cell lymphoma for whom rituximab is not generally recommended because B-cell ablation could result in more opportunistic infections. For LYG, increased frequency is associated with both congenital and acquired immunodefi ciency, such as X-linked lymphoproliferative syndrome, Wiskott–Aldrich syndrome, and HIV/ AIDS in which T-cell surveillance is defi cient (8). Thus, for a patient with LYG whose immune system might be abnormal (9), the risks associated with rituximab therapy should be considered the same as the risks for HIV/AIDS patients, and the risk for viral infection or reaction to rituximab should be recognized, particularly in areas where CMV seropositivity in the population is high (10). In addition, especially for adult and elderly patients, the gradual increase of CMV seroprevalence with age should be recognized (10). Moreover, the patient reported here had previously received cytotoxic drugs as well as maintenance steroid therapy, both of which contributed to a severely compromised immune system. These factors may have led to her acute CMV pneumonitis after receipt of rituximab. In conclusion, the potential for acute CMV reactivation should recognized during use of rituximab to treat patients with LYG. During rituximab treatment of LYG, routine monitoring for CMV reactivation and other viral infections is warranted. Shang-Gin Wu, Tzu-Hsiu Tsai, and Shang-Ju Wu Author affi liations: National Taiwan University Hospital Yun-Lin Branch, YunLin, Taiwan (S.-G. Wu); and National Taiwan University Hospital, Taipei, Taiwan (T.-H. Tsai, S.-J. Wu)