title: Acute fatal necrotizing hemorrhagic encephalitis caused by Epstein-Barr virus in a young adult immunocompetent man.
abstract: Epstein-Barr Virus (EBV) encephalitis is a rare (<1%) and generally self-limited disease with few sequelae. This neurological complication has been reported almost exclusively in the course of acute primary infection and in paediatric patients. We describe a case of a young adult immunocompetent man who developed an acute fatal necrotizing haemorrhagic encephalitis as the only manifestation of an acute EBV infection. EBV-DNA was tested positive in several CSF samples by qualitative and quantitative PCR. Serological profile showed: absence of IgM against Viral Capsid Antigen (VCA) in three different consecutive samples, presence of IgG against VCA and IgG seroconversion for Epstein Barr Nuclear Antigen (EBNA). EBV-DNA was detected by qualitative PCR in autoptic brain material. Clinical course was not influenced by antiviral therapy with acyclovir. In conclusion to our knowledge, this is the only case of acute necrotizing haemorrhagic EBV encephalitis with a fatal outcome, in an adult immunocompetent man.
authors.affiliation: Clinica di Malattie Infettive, University of Perugia, Perugia, Italy. francisd@unipg.it
authors.forename: Daniela
authors.initials: D
authors.lastname: Francisci
authors.forename: Alessandra
authors.initials: A
authors.lastname: Sensini
authors.forename: Daniela
authors.initials: D
authors.lastname: Fratini
authors.forename: Maria Vittoria
authors.initials: MV
authors.lastname: Moretti
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Luchetta
authors.forename: Antonino
authors.initials: A
authors.lastname: Di Caro
authors.forename: Giuliano
authors.initials: G
authors.lastname: Stagni
authors.forename: Franco
authors.initials: F
authors.lastname: Baldelli
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood* / Q000276:immunology; D000956:Antigens, Viral / Q000276:immunology; D001921:Brain / Q000473:pathology* / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000276:immunology / Q000473:pathology; D017809:Fatal Outcome; D004854:Herpesvirus 4, Human / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D004684:Leukoencephalitis, Acute Hemorrhagic / Q000209:etiology* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D016133:Polymerase Chain Reaction
chemical_list: D000914:Antibodies, Viral; D000956:Antigens, Viral; D004279:DNA, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M