title: Encephalomyeloradiculopathy associated with Epstein-Barr virus: primary infection or reactivation?
abstract: BACKGROUND
  Encephalomyeloradiculopathy (EMR) is a new syndrome, characterized by extensive involvement of the nervous system at different levels, including brain, medulla and spinal roots. We describe a patient presenting with prodromal febrile illness, followed by a wide infection of the nervous system with transverse myelitis and less severe meningitis, encephalitis and polyradiculopathy. The patient was treated with high-dose corticosteroids, antibiotics and acyclovir; in spite of therapy his condition improved very slowly, with severe neurological sequelae.
  
  
  METHODS
  Antiviral antibodies were searched for in serum and cerebrospinal fluid (CSF) by commercially available ELISA kits. Viral investigations were performed by cell culture isolation and search for viral antigens, and genomic nucleic acids were investigated by polymerase chain reaction (PCR).
  
  
  RESULTS
  Virological and serological studies evidenced a primary infection by cytomegalovirus (CMV), possibly responsible for the prodromal illness, persisting in the course of the disease. PCR performed in the peripheral blood mononuclear cells (PBMCs), DNA collected early and in the CSF drawn 30 days after the onset of the disease showed Epstein-Barr virus (EBV) DNA. The serum panel of EBV antibodies was typical of an intercurrent virus reactivation, more than of a primary infection.
  
  
  CONCLUSIONS
  EBV is known to be highly infectious for the nervous system, in this case of EMR the presence of DNA sequences in the PBMCs and CSF suggests that EBV plays a role in the development of this newly described syndrome.
authors.affiliation: Department of Neurology, University of Modena, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Merelli
authors.forename: R
authors.initials: R
authors.lastname: Bedin
authors.forename: P
authors.initials: P
authors.lastname: Sola
authors.forename: M
authors.initials: M
authors.lastname: Gentilini
authors.forename: P
authors.initials: P
authors.lastname: Pietrosemoli
authors.forename: M
authors.initials: M
authors.lastname: Meacci
authors.forename: M
authors.initials: M
authors.lastname: Portolani
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood / Q000134:cerebrospinal fluid; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000150:complications*; D004279:DNA, Viral / Q000097:blood / Q000134:cerebrospinal fluid; D004576:Electromyography; D004679:Encephalomyelitis / Q000097:blood / Q000134:cerebrospinal fluid / Q000503:physiopathology / Q000821:virology*; D004797:Enzyme-Linked Immunosorbent Assay; D006566:Herpesviridae Infections / Q000150:complications*; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008581:Meningitis / Q000097:blood / Q000134:cerebrospinal fluid / Q000503:physiopathology / Q000821:virology*; D009431:Neural Conduction; D016133:Polymerase Chain Reaction; D011128:Polyradiculopathy / Q000097:blood / Q000134:cerebrospinal fluid / Q000503:physiopathology / Q000821:virology*; D013577:Syndrome; D014412:Tumor Virus Infections / Q000150:complications*
chemical_list: D000914:Antibodies, Viral; D004279:DNA, Viral