title: [Case of recurrent transverse myelitis and diplopia after meningomyeloradiculitis caused by Epstein-Barr virus].
abstract: A 60-year-old woman was admitted to our hospital because of pyrexia, headache, gait disturbance, and sensory disturbance in the lower part of the body four days after she received an epidural block for postherpetic neuralgia. Neurological tests revealed neck stiffness, flaccid paraparesis in the legs with absent deep tendon reflexes, and hyperesthesia below Th7. According to a cerebrospinal fluid examination, the protein concentration was 245 mg/dl and the cell count was 176/mm3. PCR analysis of the cerebrospinal fluid was positive for Epstein-Barr virus (EBV). Serological tests for EBV yielded mild increases of serum IgG antibodies against EBV nuclear antigen (EBNA) and IgG antibodies against EBV viral capsid antigen (VCA). In a spinal MRI, the inferior lumbar meninges showed gadolinium enhancement. Nerve conduction studies revealed a decreased F wave ratio in the bilateral tibial nerves. The patient was diagnosed with meningomyeloradiculitis caused by EBV. The symptoms improved after steroid pulse therapy, but relapses of transverse myelitis and diplopia due to disturbance of the bilateral abducent nerves and left trochlear nerve occurred 7, 12, 16, and 26 months after treatment. The relapses were sometimes accompanied by small fluctuations in cerebrospinal fluid protein concentration, cell count, or serum anti-EBV antibody titer. These findings suggest that the myelopathy and diplopia were induced by a secondary immune reaction after inflammation caused by EBV infection.
authors.affiliation: Department of Geriatric Medicine, Medicine and Bioscience, Graduate School of Medicine, Ehime University.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ochi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kawajiri
authors.forename: Eri
authors.initials: E
authors.lastname: Uetani
authors.forename: Michiya
authors.initials: M
authors.lastname: Igase
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Kohara
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Miki
mesh_terms: D004172:Diplopia / Q000188:drug therapy / Q000209:etiology*; D020031:Epstein-Barr Virus Infections / Q000276:immunology; D005260:Female; D006801:Humans; D008581:Meningitis / Q000150:complications / Q000276:immunology / Q000821:virology*; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009188:Myelitis, Transverse / Q000188:drug therapy / Q000209:etiology*; D020551:Pulse Therapy, Drug; D011843:Radiculopathy / Q000150:complications / Q000276:immunology / Q000821:virology*; D012008:Recurrence
chemical_list: D008775:Methylprednisolone