Acute Epstein-Barr virus encephalitis in an immunocompetent adolescent patientA previously-healthy 16-year-old male presented with fever, headache, lethargy and seizures for a day. A hemogram showed mild lymphocytosis. Spinal fluid analysis revealed 75 leukocytes/mm3 (62% neutrophils, 35% lymphocytes, 3% monocytes) and no growth of micro-organisms in culture. Cerebral imaging studies showed an abnormal bilateral symmetrical appearance of the basal ganglia, which, together with positive IgG and IgM serology for the Epstein-Barr virus, suggested acute encephalitis by this agent (Figure). Some of the differential diagnoses were: hypoglycemia, hypoxia, intoxication (methanol, carbon monoxide, cyanide), herpes simplex infection, infantile bilateral striatal necrosis and central extrapontine myelinolysis1,2,3,4,5.
Figure
A and B. Computed tomography without administration of intravenous contrast showing the basal ganglia bilaterally ill-defined and discreetly hypodense compared to the cerebral cortex. Figures C, D, E and F. Magnetic resonance imaging of the brain show hyperintense basal ganglia bilaterally on T2-weighted sequence (C) and FLAIR (D), hypointense on T1 and without enhancement after administration of intravenous paramagnetic agent (E and F).
A and B. Computed tomography without administration of intravenous contrast showing the basal ganglia bilaterally ill-defined and discreetly hypodense compared to the cerebral cortex. Figures C, D, E and F. Magnetic resonance imaging of the brain show hyperintense basal ganglia bilaterally on T2-weighted sequence (C) and FLAIR (D), hypointense on T1 and without enhancement after administration of intravenous paramagnetic agent (E and F).
References
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1 Bekiesinska-Figatowska M, Mierzewska H, Jurkiewicz E. Basal ganglia lesions in children and adults. Eur J Radiol. 2013;82(5):837-49. https://doi.org/10.1016/j.ejrad.2012.12.006
» https://doi.org/10.1016/j.ejrad.2012.12.006 -
2 Bolis V, Karadedos C, Chiotis I, Chaliasos N, Tsabouri S. Atypical manifestations of Epstein-Barr virus in children: a diagnosticchallenge. J Pediatr (Rio J). 2016;92(2):113-21. https://doi.org/10.1016/j.jped.2015.06.007
» https://doi.org/10.1016/j.jped.2015.06.007 -
3 Saraiva M, Santos EC, Saraceni V, Rocha LLS, Monte RL, Albuquerque BC et al. Epidemiology of infectious meningitis in the State of Amazonas, Brazil. Rev Soc Bras Med Trop. 2015;48(1):79-86. https://doi.org/10.1590/0037-8682-0116-2014
» https://doi.org/10.1590/0037-8682-0116-2014 -
4 Vidal LR, Almeida SM, Messias-Reason IJ, Noguera MB, Debur MC, Pessa LFC et al. Enterovirus and herpesviridae family as etiologic agents of lymphomonocytary meningitis, Southern Brazil. Arq Neuropsiquiatr. 2011;69(3):475-81. https://doi.org/10.1590/S0004-282X2011000400013
» https://doi.org/10.1590/S0004-282X2011000400013 -
5 Teive HAG, Zavala JAA, Iwamoto FM, Bertucci-Filho D, Werneck LC. Acute cerebellitis caused by Epstein-Barr virus: case report. Arq Neuropsiquiatr. 2001;59(3A):616-8. https://doi.org/10.1590/S0004-282X2001000400027
» https://doi.org/10.1590/S0004-282X2001000400027
Publication Dates
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Publication in this collection
July 2017
History
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Received
21 Sept 2016 -
Reviewed
24 Mar 2017 -
Accepted
15 Apr 2017
