Lau Jillian S Y, Low Zhi Mei, Abbott Iain, Shochet Lani, Kanellis John, Kitching Arthur Richard, Korman Tony M
Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia.
Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia.
New Microbiol. 2017 Jul;40(3):212-217. Epub 2017 May 17.
Epstein-Barr virus (EBV) is typically associated with post transplant lymphoproliferative disease (PTLD) after solid organ and stem cell transplantation. However, it is rarely associated with neurological complications. We report a case of severe encephalitis complicating primary EBV infection six months post renal transplantation, and review the literature on EBV encephalitis in solid organ transplantation in adults. A 55-year-old male presented 6 months post cadaveric renal transplant with headache, fever and confusion. Neuroimaging was unremarkable, but an electroencephalogram was consistent with diffuse encephalopathy. EBV DNA was detected in both cerebrospinal fluid (13,177 copies/ml), and plasma (14,166 copies/ml). Management included reduction of immunosuppression, intravenous ganciclovir and intravenous immunoglobulin, and resulted in a reduction in EBV viral load in both plasma and cerebrospinal fluid. The patient made a full recovery with no long-term neurological deficits and preservation of the graft. This case highlights the importance of knowing donor and recipient EBV serostatus at time of transplant, and closely monitoring EBV DNA when there is a mismatch. Ganciclovir or valganciclovir prophylaxis has also been shown to reduce the incidence of primary EBV infection in renal transplantation in these recipients. Treatment options for EBV infection post-transplant include reduction of immunosuppression, antiviral therapy, IVIg, and monoclonal antibody therapy directed toward infected B lymphocytes.
爱泼斯坦-巴尔病毒（EBV）通常与实体器官和干细胞移植后的移植后淋巴细胞增生性疾病（PTLD）相关。然而，它很少与神经系统并发症相关。我们报告一例肾移植术后6个月原发性EBV感染并发严重脑炎的病例，并回顾成人实体器官移植中EBV脑炎的相关文献。一名55岁男性在尸体肾移植术后6个月出现头痛、发热和意识模糊。神经影像学检查无异常，但脑电图符合弥漫性脑病表现。脑脊液（13,177拷贝/ml）和血浆（14,166拷贝/ml）中均检测到EBV DNA。治疗措施包括减少免疫抑制、静脉注射更昔洛韦和静脉注射免疫球蛋白，结果血浆和脑脊液中的EBV病毒载量均降低。患者完全康复，无长期神经功能缺损，移植肾得以保留。该病例强调了在移植时了解供体和受体EBV血清学状态的重要性，以及在出现不匹配时密切监测EBV DNA的重要性。在这些受者的肾移植中，更昔洛韦或缬更昔洛韦预防也已显示可降低原发性EBV感染的发生率。移植后EBV感染的治疗选择包括减少免疫抑制、抗病毒治疗、静脉注射免疫球蛋白以及针对感染B淋巴细胞的单克隆抗体治疗。
