Proven Epstein-Barr encephalitis with negative EBV-DNA load in cerebrospinal fluid after allogeneic hematopoietic stem cell transplantation in a child with acute lymphoblastic leukemia.
We report a case of EBV encephalitis in a seven-yr-old child with Ph+ ALL. Two months after an allogeneic HSCT from his HLA mismatched mother, the patient showed an altered sensorium, generalized seizures, and a left hemiparesis. Brain MRI demonstrated multiple lesions highly suggestive for viral encephalitis. Blood and CSF PCR analyses were negative for the most common viruses involved in immunocompromised patients including EBV. A cerebral biopsy was performed, which showed intense gliosis and perivascular lymphocytic cuffing. PCR analysis performed on brain tissue was positive only for the EBV genome, while extensive investigations for other viral infections were negative. The patient's neurological symptoms rapidly worsened and he died two months later. This case report suggests that in patients presenting neurological and radiological signs of encephalitis after an HSCT, an EBV involvement should be considered, even in the absence of CSF and blood PCR virus detection.
Division of Hematology, Department of Cellular Biotechnologies and Hematology, "Sapienza" University, Rome, Italy.
Walter
W
Barberi
Salvatore
S
Perrone
Anna Paola
AP
Iori
Giovanni Fernando
GF
Torelli
Anna Maria
AM
Testi
Maria Luisa
ML
Moleti
Teresa
T
Ceglie
Paola
P
Papoff
Elena
E
Caresta
Manila
M
Antonelli
Francesca
F
Gianno
Antonio
A
Melone
Manuela
M
Badiali
Felice
F
Giangaspero
Robin
R
Foà
Giuseppe
G
Gentile
D002648:Child; D004279:DNA, Viral / Q000134:cerebrospinal fluid*; D018792:Encephalitis, Viral / Q000134:cerebrospinal fluid*; D020031:Epstein-Barr Virus Infections / Q000134:cerebrospinal fluid*; D005188:False Negative Reactions; D018380:Hematopoietic Stem Cell Transplantation; D004854:Herpesvirus 4, Human / Q000235:genetics*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000134:cerebrospinal fluid*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000601:surgery*; D014184:Transplantation, Homologous
D004279:DNA, Viral
Epstein-Barr virus; cerebrospinal fluid; encephalitis; hematopoietic stem cell transplantation; leukemia