Epstein-Barr virus-associated meningoencephalomyelitis: intrathecal reactivation of the virus in an immunocompetent child.
Neurologic complications, including meningoencephalitis, transverse myelitis, and peripheral neuropathy, have been reported in patients with acute infectious mononucleosis. Chronic active Epstein-Barr virus and human immunodeficiency virus infections occasionally induce central nervous system lymphoma. On the other hand, central nervous system disease alone associated with Epstein-Barr virus rarely occurs in previously healthy individuals. A 15-year-old girl who developed acute disseminated encephalomyelitis-like disease presenting fever, anuresis, diplopia, and muscle weakness is described here. Clinical and neuroimaging studies led to the diagnosis of encephalomyelitis. Despite the absence of infectious mononucleosis-like symptoms, anti-Epstein-Barr virus antibody titers in serum and cerebrospinal fluid showed the virus reactivation. The copy number of Epstein-Barr virus DNA increased in cerebrospinal fluid but not in peripheral blood. Ganciclovir and repeated methyl-prednisolone pulse therapy resulted in complete resolution. Central nervous system disease on the limited intrathecal reactivation of Epstein-Barr virus in immunocompetent children should be differentiated from acute disseminated encephalomyelitis.
Sanefuji
Masafumi
M
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Ohga
Shouichi
S
Kira
Ryutaro
R
Nomura
Akihiko
A
Torisu
Hiroyuki
H
Takada
Hidetoshi
H
Kusuhara
Koichi
K
Hara
Toshiro
T
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001921:Brain / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D018792:Encephalitis, Viral / Q000276:immunology / Q000503:physiopathology / Q000821:virology*; D005260:Female; D018628:Gene Dosage / Q000235:genetics; D004854:Herpesvirus 4, Human / Q000502:physiology*; D006801:Humans; D007121:Immunocompetence / Q000276:immunology; D007244:Infectious Mononucleosis / Q000150:complications* / Q000821:virology*; D008279:Magnetic Resonance Imaging; D008578:Meninges / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D008587:Meningitis, Viral / Q000276:immunology / Q000503:physiopathology / Q000821:virology*; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D013346:Subarachnoid Space / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D016896:Treatment Outcome; D019562:Viral Load; D014779:Virus Replication / Q000502:physiology*
D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D004279:DNA, Viral