VanderVeen Nathan, Nguyen Nikki, Hoang Kenny, Parviz Jason, Khan Tahuriah, Zhen Andrew, Jagger Brett W
Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI USA.
David Geffen School of Medicine at UCLA, Division of Medicine-Pediatrics, Los Angeles, CA USA.
IDCases. 2020 Oct 8;22:e00966. doi: 10.1016/j.idcr.2020.e00966. eCollection 2020.
We present the case of a 59-year-old Midwestern farmer who presented with altered mental status, dysarthria, urinary incontinence, and a right-sided L5 dermatomal rash; he had recently received a course of oral corticosteroids for treatment of radicular low back pain. Lumbar puncture revealed the presence of varicella zoster virus (VZV) and IgM antibodies against a California-group encephalitis virus, later confirmed as Jamestown Canyon virus (JCV). Unfortunately, the patient's health declined despite aggressive treatment, developing progressive subarachnoid hemorrhage. He died after withdrawal of supportive care following 3 weeks in the intensive care unit. To our knowledge, this is the first documented case of encephalitis associated with coinfection by VZV and JCV. While the relative contributions of these viral pathogens to the patient's illness are difficult to ascertain, the clinical features of this case are consistent with co-pathogenesis, possibly driven by antecedent corticosteroid use. This case highlights the emerging role of viral coinfections in the etiology of viral illnesses.
我们报告了一例59岁的中西部农民病例，该患者出现精神状态改变、构音障碍、尿失禁以及右侧L5皮节皮疹；他近期接受了一个疗程的口服皮质类固醇治疗神经根型腰痛。腰椎穿刺显示存在水痘带状疱疹病毒（VZV）以及针对加利福尼亚组脑炎病毒的IgM抗体，后被确认为詹姆斯敦峡谷病毒（JCV）。不幸的是，尽管积极治疗，患者的健康状况仍恶化，出现进行性蛛网膜下腔出血。在重症监护病房治疗3周后，在停止支持治疗后患者死亡。据我们所知，这是首例记录在案的由VZV和JCV合并感染引起的脑炎病例。虽然这些病毒病原体对患者疾病的相对作用难以确定，但该病例的临床特征与共同发病机制相符，可能是由先前使用皮质类固醇所驱动。该病例凸显了病毒合并感染在病毒性疾病病因学中日益重要的作用。
