Zaguri Reut, Shelef Ilan, Ifergan Gal, Almog Yaniv
Soroka University Medical Center, PO Box 151, Beer-Sheva, 84101, Israel.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.07.2008.0443. Epub 2009 Mar 17.
We present the case of a young man with recent cytomegalovirus (CMV) infection who was admitted with generalised seizure and coma. Computed tomography scan and magnetic resonance imaging (MRI) on admission were normal. Despite transient initial improvement he rapidly deteriorated leading to repeated MRI that revealed findings highly suggestive of acute haemorrhagic leucoencephalitis (AHLE). The patient died despite treatment with pulse methylprednisolone and intravenous immunoglobulin. Acute disseminated encephalomyelitis (ADEM)/AHLE should be considered in the differential diagnosis of rapid neurological deterioration even when initial imaging is normal. This case report underscores the importance of early diagnosis as early aggressive treatment may improve outcome.
我们报告了一例近期感染巨细胞病毒（CMV）的年轻男性病例，该患者因全身性癫痫发作和昏迷入院。入院时的计算机断层扫描和磁共振成像（MRI）均正常。尽管最初有短暂改善，但他很快病情恶化，随后重复进行的MRI显示出高度提示急性出血性白质脑炎（AHLE）的表现。尽管使用了大剂量甲基强的松龙和静脉注射免疫球蛋白进行治疗，患者仍死亡。即使初始影像学检查正常，在快速神经功能恶化的鉴别诊断中也应考虑急性播散性脑脊髓炎（ADEM）/AHLE。本病例报告强调了早期诊断的重要性，因为早期积极治疗可能改善预后。
