Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.
Department of Hematology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, The Netherlands.
J Neurovirol. 2019 Jun;25(3):422-425. doi: 10.1007/s13365-018-0718-1. Epub 2019 Jan 22.
A 21-year-old female presented with headache, nausea and vomiting, dysarthria, difficulty finding words, vertigo, episodical diplopia and an abnormal gait since 2 days. Additionally, we found marked ataxia and disturbed liver chemistry whilst her infection parameters were low. Her head CT scan was unremarkable, but her MRI scan showed leptomeningeal enhancement along the cerebellar folia. A lumbar punction revealed mononuclear leucocytosis and increased protein in her cerebrospinal fluid. She was admitted on a working diagnosis of herpes simplex encephalitis. Shortly after admission, she had a generalised seizure. She was tested for a wide range of viruses, bacteria and auto-immune antibodies and treated empirically with aciclovir, ceftriaxone, doxycycline and intravenous immunoglobulins. All tests continued to come back negative until the fifth day of admission, when repeat Epstein-Barr virus (EBV) serology showed evidence of an acute EBV infection, even though negative tests were acquired at admission. EBV encephalitis is a rare complication of EBV infection that is usually restricted to children and immune-compromised individuals. This is only the fifth case describing EBV encephalitis in an immune-competent adult, presenting with unique clinical features including a lack of fever and leptomeningeal enhancement on MRI investigation. Most interestingly, she tested negative for EBV until a few days after admission, underlining the need for repeated investigations in suspected virological encepahlitis. Even though our patient did not receive the often recommended glucocorticosteroids, she made a good neurological recovery.
一位 21 岁女性因头痛、恶心和呕吐、构音障碍、言语困难、眩晕、间歇性复视和异常步态 2 天就诊。此外，我们发现她明显共济失调和肝功能障碍，而感染参数较低。头部 CT 扫描未见异常，但 MRI 扫描显示小脑叶片脑膜增强。腰椎穿刺显示脑脊液单核细胞白细胞增多和蛋白增加。她被诊断为单纯疱疹脑炎入院。入院后不久，她出现全身性癫痫发作。她接受了广泛的病毒、细菌和自身免疫抗体检测，并经验性地接受了阿昔洛韦、头孢曲松、强力霉素和静脉注射免疫球蛋白治疗。所有检测结果持续呈阴性，直到入院第 5 天，重复的 EBV 血清学检查显示急性 EBV 感染的证据，尽管入院时检测结果为阴性。EBV 脑炎是 EBV 感染的罕见并发症，通常局限于儿童和免疫功能低下者。这是第五例描述免疫功能正常的成人 EBV 脑炎，其独特的临床表现包括缺乏发热和 MRI 检查脑膜增强。最有趣的是，她在入院几天后才检测到 EBV 呈阴性，这强调了在疑似病毒性脑炎中需要重复检查。尽管我们的患者没有接受通常推荐的糖皮质激素治疗，但她的神经功能恢复良好。
