Stone Joshua A, Knoll Bettina M, Farmakiotis Dimitrios
Department of Neurology, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI, United States.
Transplant Infectious Diseases, Westchester Medical Center and New York Medical College, Valhalla, NY, United States.
IDCases. 2017 Sep 28;10:83-87. doi: 10.1016/j.idcr.2017.09.009. eCollection 2017.
In solid organ transplant recipients, Epstein-Barr virus (EBV) can cause active central nervous system (CNS) infection or malignant transformation of latently infected cells in the CNS, known as post-transplant lymphoproliferative disease (PTLD). Reduction of T-cell immunosuppression is the cornerstone of management. The role of antivirals with activity against herpesviruses in EBV-related CNS syndromes is controversial, as they have no effect on latent virus. We report an unusual case of relapsing EBV encephalitis in a donor-positive, EBV-negative renal transplant recipient, with response to valganciclovir. Our report supports the utility of antiviral treatment for EBV encephalitis, as adjunct to reducing immunosuppression, and highlights the need for a systematic approach and long-term, multi-disciplinary follow-up of such patients.
在实体器官移植受者中，爱泼斯坦-巴尔病毒（EBV）可引起中枢神经系统（CNS）的活动性感染或CNS中潜伏感染细胞的恶性转化，即移植后淋巴细胞增殖性疾病（PTLD）。减少T细胞免疫抑制是治疗的基石。对疱疹病毒有活性的抗病毒药物在EBV相关中枢神经系统综合征中的作用存在争议，因为它们对潜伏病毒没有作用。我们报告了1例供体EBV阳性、受者EBV阴性的肾移植受者复发性EBV脑炎的罕见病例，该患者对缬更昔洛韦有反应。我们的报告支持抗病毒治疗作为减少免疫抑制的辅助手段用于EBV脑炎的效用，并强调对此类患者需要采取系统的方法以及进行长期的多学科随访。
