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Peer-reviewedCC BY 4.0Frontiers in Immunology

A case report of influenza-triggered RANBP2-associated acute necrotizing encephalomyelitis in an adult successfully treated with tocilizumab

  • Marie-Anne Heusler1
  • Sofia Sandgren2,3
  • Jens Kuhle2,3
  • Stephan Rüegg2
  • Özgür Yaldizli2,3
  • Cristina Granziera2,3
  • Marten Trendelenburg1
  • Severin Bausch1
  1. 1Division of Internal Medicine, University Hospital of Basel
  2. 2Department of Neurology, University Hospital and University of Basel
  3. 3Multiple Sclerosis Centre and Research Centre for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Department of Biomedicine and Clinical Research, University Hospital and University of Basel
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Abstract

Here, we report a rare case of a 32-year-old patient presenting with a second episode of influenza A-triggered acute necrotizing encephalomyelitis (ANE) in the context of a Ran-binding protein 2 (RANBP2) -mutation, which was diagnosed after a previous influenza-triggered ANE at the age of eleven. Despite early treatment with corticosteroids, plasmapheresis and intravenous immunoglobulins (IVIG) no meaningful clinical improvement was observed during the first 6 weeks of treatment. As interleukin-6 (IL-6) levels were elevated in both blood and cerebrospinal fluid (CSF), additional therapy with tocilizumab was initiated, leading to clinical improvement from week 11 onward.

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Cite

BibTeXRIS
BibTeX
@article{heusler2026case,
  title = {{A case report of influenza-triggered RANBP2-associated acute necrotizing encephalomyelitis in an adult successfully treated with tocilizumab}},
  author = {Marie-Anne Heusler and Sofia Sandgren and Jens Kuhle and Stephan Rüegg and Özgür Yaldizli and Cristina Granziera and Marten Trendelenburg and Severin Bausch},
  journal = {Frontiers in Immunology},
  year = {2026},
  month = oct,
  doi = {10.3389/fimmu.2026.1866407},
  url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1866407/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - A case report of influenza-triggered RANBP2-associated acute necrotizing encephalomyelitis in an adult successfully treated with tocilizumab
AU  - Marie-Anne Heusler
AU  - Sofia Sandgren
AU  - Jens Kuhle
AU  - Stephan Rüegg
AU  - Özgür Yaldizli
AU  - Cristina Granziera
AU  - Marten Trendelenburg
AU  - Severin Bausch
PY  - 2026
DA  - 2026/10/28
JO  - Frontiers in Immunology
DO  - 10.3389/fimmu.2026.1866407
UR  - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1866407/full
AB  - Here, we report a rare case of a 32-year-old patient presenting with a second episode of influenza A-triggered acute necrotizing encephalomyelitis (ANE) in the context of a Ran-binding protein 2 (RANBP2) -mutation, which was diagnosed after a previous influenza-triggered ANE at the age of eleven. Despite early treatment with corticosteroids, plasmapheresis and intravenous immunoglobulins (IVIG) no meaningful clinical improvement was observed during the first 6 weeks of treatment. As interleukin-6 (IL-6) levels were elevated in both blood and cerebrospinal fluid (CSF), additional therapy with tocilizumab was initiated, leading to clinical improvement from week 11 onward.
SN  - 1664-3224
ER  -