Abstract
Epstein Barr virus (EBV) infects about 90 % of people in the first decade of life and, like other herpes viruses, remains dormant with risk of subsequent reactivations. EBV infection can have an asymptomatic course or cause infectious mononucleosis (IM), especially in teenagers and adults. Rarely, it can be responsible for infections in the central nervous system such as encephalitis, cerebellitis, myelitis, neuritis, acute disseminated encephalomyelitis and, more commonly, primary lymphoma of the central nervous system (PLCNS) related to infection by human immunodeficiency virus (HIV). VEB encephalitis does not differ from other viral encephalitis in its clinical presentation. Its diagnosis is performed by serological detection of acute antibody response against the virus or by polymerase chain reaction (PCR) in cerebrospinal fluid (CSF). Treatment options are limited and with a low evidence of effectiveness. We report an unusual case of an immunocompetent mid adult woman, who presented clinically severe acute encephalitis and marked abnormalities in neuroimaging. The diagnosis was made by EBV DNA detection in CSF, supported by the exclusion of the presence of other pathogens and etiologies by microbiological and pathological studies.
References
Meyding Lamade U, Strank C. Herpesvirus infections of the central nervous system in immunocompromised patients. Ther Adv Neurol Disord. 2012;5(5):279-96.
Bathoorn E, Vlaminckx BJM, Schoondermark-Stolk S, Donders R, Van Der Meulen M, Thijsen SFT. Primary Epstein-Barr virus infection with neurological complications. Scand J Infect Dis. 2011;43(2):136-44.
Calore EE, Pérez NM, Martins JF, Cárdenas PG. Inmunohisto-química en un caso de encefalitis por virus de Epstein. Rev Chilena Infectol. 2012;29(6):687-8.
Tselis AC. Epstein-Barr virus infections of the nervous system. Handb Clin Neurol. 2014;123:285-305.
Veroni C, Marnetto F, Granieri L, Bertolotto A, Ballerini C, Repice AM, et al. Immune and Epstein-Barr virus gene expression in cerebrospinal fluid and peripheral blood mononuclear cells from patients with relapsing-remitting multiple sclerosis. J Neuroinflammation. 2015;12(1):1-18.
Martelius T, Lappalainen M, Palomaki M, Anttila VJ. Clinical characteristics of patients with Epstein Barr virus in cerebrospinal fluid. BMC Infect Dis. 2011;11:2-6.
Fujimoto H, Asaoka K, Imaizumi T, Ayabe M, Shoji H, Kaji M. Epstein-Barr virus infections of the central nervous system. Intern Med. 2003;42(1):33-40.
Di Carlo P, Trizzino M, Titone L, Capra G, Colletti P, Mazzola G, et al. Unusual MRI findings in an immunocompetent patient with EBV encephalitis: A case report. BMC Med Imaging. 2011;11(1):6.
Kleines M, Schiefer J, Stienen A, Blaum M, Ritter K, Hausler M. Expanding the spec-trum of neurological disease associated with Epstein-Barr virus activity. Eur J Clin Microbiol Infect Dis. 2011;30(12):1561-9.
Gaeta A, Verzaro S, Cristina LM, Mancini C, Nazzari C. Diagnosis of neurological herpesvirus infections: Real time PCR in cerebral spinal fluid analysis. New Microbiol. 2009;32(4):333-40.
Hsu CC, Tokarz R, Briese T, Tsai HC, Quan PL, Ian Lipkin W. Use of staged molecular analysis to determine causes of unexplained central nervous system infections. Emerg Infect Dis. 2013;19(9):1470-7.
De Ory F, Avellón A, Echevarría JE, Sánchez-Seco MP, Trallero G, Cabrerizo M, et al. Viral infections of the central nervous system in Spain: A prospective study. J Med Virol. 2013;85(3):554-62.
Pinto J, Carvalho S, Pereira C, Figueira C, Robalo C. A case of Epstein-Barr encephalitis with some curiosities. Neuroradiol J. 2015;28(6):559-61.
Hashemian S, Ashrafzadeh F, Akhondian J, Beiraghi Toosi M. Epstein-barr virus encephalitis: A case report. Iran J Child Neurol. 2015;9(1):107-10.
Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL, et al. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2008;47(3):303-27.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.