Division of Clinical Neurosciences, University of Turku and Turku University Hospital, Turku, Finland.
J Med Virol. 2013 Nov;85(11):1935-9. doi: 10.1002/jmv.23683. Epub 2013 Jul 12.
This study reports a previously healthy, immunocompetent adult male in whom human herpesvirus 7 (HHV-7) DNA was detected continuously from the cerebrospinal fluid (CSF). This patient developed definite sarcoidosis with primary symptomatic manifestations in the central nervous system (CNS). The initial presentation was with loss of visual acuity and papilledema. Brain MR imaging at presentation confirmed papilledema, but otherwise there were no focal abnormalities or signs of hydrocephalus. CSF investigation revealed pleocytosis and elevated protein levels. HHV-7 DNA was detected repeatedly from CSF but not from blood over 1 year follow-up. High resolution computed tomography of lungs was normal. Positron emission tomography showed several metabolically active lymph nodes in the mediastinum, and the histopathological investigation revealed granulomatous inflammation consistent with sarcoidosis. The finding of HHV-7 DNA in the CSF in the context of neurosarcoidosis has not been reported previously. The detection of HHV-7 DNA may result from the selective activation of CD4+ T-lymphocytes in the CSF caused by neurosarcoidosis. Further studies are needed to establish whether the detection of HHV-7 DNA in the CSF in association with neurosarcoidosis represents a clinically significant HHV-7 CNS infection.
本研究报告了一例先前健康、免疫功能正常的成年男性，其脑脊液（CSF）中持续检测到人类疱疹病毒 7 型（HHV-7）DNA。该患者发生明确的结节病，且以中枢神经系统（CNS）的原发性症状表现。首发症状为视力丧失和视盘水肿。初诊时的脑部磁共振成像（MRI）证实了视盘水肿，但无其他局灶性异常或脑积水征象。CSF 检查显示细胞增多和蛋白水平升高。在 1 年的随访期间，HHV-7 DNA 反复从 CSF 中检测到，但从未从血液中检测到。肺部高分辨率计算机断层扫描正常。正电子发射断层扫描（PET）显示纵隔内有几个代谢活跃的淋巴结，组织病理学检查显示符合结节病的肉芽肿性炎症。神经结节病患者脑脊液中存在 HHV-7 DNA 的发现以前尚未报道过。CSF 中的 HHV-7 DNA 检测可能是由于神经结节病导致 CSF 中的 CD4+T 淋巴细胞选择性激活。需要进一步研究以确定神经结节病患者 CSF 中 HHV-7 DNA 的检测是否代表有临床意义的 HHV-7 CNS 感染。
