title: [Recurrence of chronic active Epstein-Barr virus infection presenting with myelopathy after umbilical cord blood transplantation].
abstract: A 38-year-old man was admitted to our hospital with neck pain, dysesthesia of both hands, and weakness of the left upper limb. He had been diagnosed with a chronic active Epstein-Barr virus infection (CAEBV) at the age of 34 and had undergone umbilical cord blood transplantation at the age of 37. MRI of the spinal cord revealed an intramedullary hyperintense lesion on T₂-weighted images with gadolinium enhancement. Because his laboratory tests revealed proliferation of CD19(+) lymphocytes in the peripheral blood, and EBV DNA was detected in both peripheral blood and CSF, he was diagnosed as having post-transplant EBV associated lymphoproliferative disease. However, chemotherapy did not alleviate his symptoms. At a later time, quantitative chimerism analysis of his CSF showed a higher proportion of lymphocytes that had originated from the recipient. Finally, he was diagnosed as having a recurrence of CAEBV in the central nervous system, and his symptoms were restored by intrathecal chemotherapy (methotrexate, cytosine arabinoside, and prednisolone). Quantitative chimerism analysis of CSF was useful for diagnosing the recurrence of CAEBV in the central nervous system.
authors.affiliation: Department of Internal Medicine, Division of Neurology, Hyogo College of Medicine.
authors.forename: Shohei
authors.initials: S
authors.lastname: Watanabe
authors.forename: Masaya
authors.initials: M
authors.lastname: Okada
authors.forename: Tazuko
authors.initials: T
authors.lastname: Tokugawa
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sawada
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ogawa
authors.forename: Hiroo
authors.initials: H
authors.lastname: Yoshikawa
mesh_terms: D000328:Adult; D002908:Chronic Disease; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D020031:Epstein-Barr Virus Infections; D006801:Humans; D008297:Male; D009187:Myelitis / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000821:virology*; D012008:Recurrence; D018183:Transplantation Chimera