title: Enterovirus causes rapidly progressive dementia in a 28-year-old immunosuppressed woman.
abstract: Enterovirus in the nervous system can present with protean manifestations, including polio-like paralysis, movement disorders, and seizures. This is a report of a single case of a rapidly progressive dementing illness in a young woman with common variable immunodeficiency (CVID). Over the course of several months, she developed profound aphasia, apraxia, and cerebellar signs. She underwent brain biopsy which was suggestive of toxoplasmosis; despite an adequate course of treatment, she continued to decline and ultimately died. Autopsy and PCR testing revealed diffuse coxsackie B3 infiltration in the meninges and brain parenchyma. To our knowledge, this is the first description of enterovirus causing a dementing illness in a young immunosuppressed adult. We highlight the need for a broad differential diagnosis, especially for immunocompromised individuals, who may present in an atypical fashion.
authors.affiliation: Department of Neurology, University of Virginia, 1215 Lee St, PO Box 800394, Charlottesville, VA, 22908, USA. sam6h@hscmail.mcc.virginia.edu.
authors.forename: Sneha
authors.initials: S
authors.lastname: Mantri
authors.affiliation: Department of Neurology, University of Virginia, 1215 Lee St, PO Box 800394, Charlottesville, VA, 22908, USA.
authors.forename: Binit B
authors.initials: BB
authors.lastname: Shah
mesh_terms: D000328:Adult; D001921:Brain / Q000276:immunology / Q000473:pathology / Q000821:virology; D017074:Common Variable Immunodeficiency / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000821:virology; D003704:Dementia / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000821:virology; D003937:Diagnosis, Differential; D029822:Enterovirus B, Human / Q000276:immunology / Q000472:pathogenicity*; D004769:Enterovirus Infections / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000821:virology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host
keywords: Cognitive impairment; Common variable immunodeficiency; Coxsackievirus; Enterovirus