title: Persistent Coxsackie B encephalitis: Report of a case and review of the literature.
abstract: Although the diagnosis is rarely confirmed, enteroviruses are a common cause of meningitis. Coxsackie B is responsible for more than half of the cases of aseptic meningitis in infants less than 3 months old, but is less common as a cause of neurological disease in older persons. In addition to aseptic meningitis, Coxsackie B has been reported to cause a wide range of other neurological disorders, albeit rarely. The authors report a young adult with persistent Coxsackie B encephalitis that was heralded by focal seizures and evolved to intractable coma with multifocal myoclonus. The diagnosis was established by immunohistochemistry and reverse transcriptase-polymerase chain reaction (RT-PCR) on tissue obtained at brain biopsy. Cerebrospinal fluid (CSF) viral cultures and PCR were negative for enteroviruses. This case highlights unusual features of a persistent infection that could easily have been mistaken for a neurodegenerative or other noninfectious process. It also emphasizes the importance of performing brain biopsy on individuals with neurological disease of obscure nature.
authors.affiliation: Department of Neurology, Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky 40536-0284, USA.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Berger
authors.forename: Warren
authors.initials: W
authors.lastname: Chumley
authors.forename: Thomas
authors.initials: T
authors.lastname: Pittman
authors.forename: Curtis
authors.initials: C
authors.lastname: Given
authors.forename: Gerard
authors.initials: G
authors.lastname: Nuovo
mesh_terms: D000328:Adult; D001706:Biopsy; D001921:Brain / Q000473:pathology* / Q000821:virology*; D003937:Diagnosis, Differential; D018792:Encephalitis, Viral / Q000175:diagnosis*; D029822:Enterovirus B, Human; D004769:Enterovirus Infections / Q000150:complications / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D019636:Neurodegenerative Diseases; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012640:Seizures / Q000209:etiology; D014057:Tomography, X-Ray Computed