Shroff Sheetal, Kamiya-Matsuoka Carlos, Woodman Karin
The University of Texas MD Anderson Cancer Center, Department of Neuro-Oncology, Houston, TX, United States; The University of Texas Medical Branch, Department of Neurology, Galveston, TX, United States.
The University of Texas MD Anderson Cancer Center, Department of Neuro-Oncology, Houston, TX, United States; The University of Texas Medical Branch, Department of Neurology, Galveston, TX, United States.
J Neurol Sci. 2014 May 15;340(1-2):218-20. doi: 10.1016/j.jns.2014.02.023. Epub 2014 Feb 26.
Parvovirus B19 is a single-stranded DNA virus belonging to the family Parvoviridae, genus Erythrovirus. PVB19 infection is most common in the pediatric population, manifesting as erythema infectiosum. In patients with hemoglobinopathy, PVB19 infection is known to cause aplastic anemia. PVB19 infection rarely affects the nervous system - reported manifestations include seizures, encephalitis and meningoencephalitis. Less common presentations include stroke, cerebellar ataxia, optic neuritis, brachial plexitis, Guillain-Barré syndrome and carpal tunnel syndrome.
Review the different central nervous system (CNS) manifestations and treatment strategies in all reported cases of adult CNS PVB19 infection.
Cerebellar ataxia is a very rare manifestation of PVB19 CNS infection. Our patient had refractory chronic lymphocytic leukemia and PVB19 in bone marrow and serum; he presented with 6-week history of progressive pan-cerebellar ataxia. CSF was acellular but PVB19 was present on PCR test. Early treatment with intravenous immunoglobulin (IVIG) led to improvement in the patient's neurological deficits.
PVB19 CNS infection should be in the differential as a cause of cerebellar ataxia in immunocompromised patients. Recognition is critical to early institution of appropriate therapy. Our patient showed considerable improvement in ataxia after IVIG therapy.
细小病毒B19是一种单链DNA病毒，属于细小病毒科红病毒属。B19感染在儿童群体中最为常见，表现为传染性红斑。在患有血红蛋白病的患者中，已知B19感染会导致再生障碍性贫血。B19感染很少影响神经系统——报告的表现包括癫痫发作、脑炎和脑膜脑炎。较不常见的表现包括中风、小脑共济失调、视神经炎、臂丛神经炎、格林-巴利综合征和腕管综合征。
回顾所有已报告的成人中枢神经系统B19感染病例的不同中枢神经系统（CNS）表现及治疗策略。
小脑共济失调是B19中枢神经系统感染非常罕见的表现。我们的患者患有难治性慢性淋巴细胞白血病，骨髓和血清中存在B19；他出现了6周的进行性全小脑共济失调病史。脑脊液无细胞，但PCR检测显示存在B19。早期静脉注射免疫球蛋白（IVIG）治疗使患者的神经功能缺损得到改善。
B19中枢神经系统感染应作为免疫功能低下患者小脑共济失调的病因之一进行鉴别诊断。认识到这一点对于早期开展适当治疗至关重要。我们的患者在接受IVIG治疗后共济失调有了显著改善。
