Hemorrhagic encephalitis associated with Epstein-Barr virus infection

Epstein-Barr virus (EBV) encephalitis is a rare neurological complication, usually only reported in pediatric patients. We present a 20-year-old, previously healthy male who developed hemorrhagic encephalitis caused by EBV. He was admitted to our hospital with a 1-week history of fever, diarrhea, headache, and confusion. Brain T2-weighted MRI showed a focal area of increased signal in the right temporal lobe. Brain MRI and CT scans on day 2 revealed progression of the lesion, with partial hemorrhagic change, acute brain swelling, and severe midline shift. The patient underwent external decompression and external ventricular drainage. EBV DNA was identified in brain biopsy specimens by polymerase chain reaction. The postoperative course was uneventful. To our knowledge, this is the second report of hemorrhagic EBV encephalitis in an adult.     

Poliomyelitis-like syndrome associated with Epstein-Barr virus infection

A 20-month-old male presented with an acute clinical syndrome resembling poliomyelitis, characterized by a flaccid monoplegia, areflexia of the involved limb, and preserved sensation. Electrophysiologic studies supported a neuronopathic localization involving the anterior horn cells. Although laboratory evidence for a poliovirus infection was absent, serologic and polymerase chain reaction studies documented an active central nervous system infection with Epstein-Barr virus, indicating that a poliomyelitis-like syndrome may be produced by infectious agents other than enteroviruses.     

Acute psychosis in a patient with Epstein-Barr virus infection

A case study is presented of an adolescent female who became psychotic and attempted suicide during an acute Epstein-Barr Virus infection. Resolution of the infection resulted in the patient returning to her previous normal mental status. The adolescent's ingestion of acetaminophen masked the signs and symptoms of infection and delayed proper diagnosis.     

Leukocytoclastic-vasculitic neuropathy associated with chronic Epstein-Barr virus infection

We report a patient with leukocytoclastic-vasculitic neuropathy associated with chronic Epstein-Barr virus (EBV) infection. A 55-year-old man had been suffering from chronic progressive axonal polyneuropathy and skin erythema for 3 years. A skin biopsy showed capillary vasculitis with clustered leukocyte fragments. Findings of serum assays, a polymerase chain reaction for EBV-DNA, and in situ hybridization indicated chronic EBV infection. Immunosuppressive treatment resulted in the gradual lessening of his general and neurologic symptoms.     

Unusual acute neurologic presentations with Epstein-Barr virus infection

We describe two patients with serologic evidence of active Epstein-Barr virus infection who presented with unusual neurologic manifestations and minimal systemic findings of infectious mononucleosis. One girl developed an acute hemiplegic migraine syndrome followed by acute psychosis, and the other patient had severe, generalized chorea. The wide spectrum of presenting central nervous system findings associated with Epstein-Barr virus infections underscores the need to suspect this agent in a variety of acute neurologic syndromes.     

Improvement of a CIDP associated with hepatitis C virus infection using antiviral therapy

A 57-year-old man with chronic inflammatory demyelinating polyneuropathy associated with hepatitis C virus infection was treated successfully with the combination of peginterferon-alpha-2b and ribavirin. Viral eradication was confirmed during the 4th week of treatment and was followed 3 weeks later by neurologic improvement. The patient resumed normal activity 1 year after the therapy was completed.     

Radiculoplexopathy with conduction block caused by acute Epstein-Barr virus infection

The authors report a case of cervicobrachial radiculoplexopathy with proximal conduction block (CB), associated with acute Epstein-Barr virus (EBV) infection. The patient presented with pain, paresthesias, and monomelic weakness in the left C7-8, and T1 myotomes. The illness was monophasic with rapid recovery. Neurophysiologic studies demonstrated CB in the proximal left median and ulnar nerve segments. The authors conclude that this syndrome resulted from a postinfectious process following acute EBV infection.     

Generalized myositis mimicking polymyositis associated with chronic active Epstein-Barr virus infection

Background Chronic generalized myositis has not so far been reported as a complication of chronic active Epstein–Barr virus infection (CAEBV). We encountered three patients with chronic generalized myositis mimicking polymyositis associated with CAEBV. Methods To clarify the pathological character of this myositis, we investigated the distribution, clonality, and the immunophenotype of EBV–infected cells and lymphocytes infiltrating in muscles. Results Clinically, two patients showed symmetrical proximal weakness and muscle atrophy as the initial and main symptom. Although the condition resembled polymyositis, they had also lingual and/or orbital myositis. The other patient showed generalized myositis at the late phase of CAEBV. In all of them, immunotherapy was ineffective and prognosis was poor. Intramuscular infiltrating lymphocytes in our patients were mainly CD45RO+, CD3+, CD4–, CD8–, TCR F1–, TCR TCS1–, CD56–, CD79a–, CD21–, HLA-DR+, ZEBRA –, LMP1–, and EBER+ T cells. Oligoclonal expansion of EBV–infected T cells was shown in the muscles. However, there were no malignant lymphocytes. Conclusions This new form of myositis must be distinguished from polymyositis and the other conventional forms of myositis. Careful investigation of hidden CAEBV is recommended when patients present with steroid non–responsive chronic progressive generalized myositis, in particular, with lingual or orbital involvement.     

Encephalomyeloradiculopathy associated with Epstein-Barr virus: primary infection or reactivation?

Introduction - Encephalomyeloradiculopathy (EMR) is a new syndrome, characterized by extensive involvement of the nervous system at different levels, including brain, medulla and spinal roots. We describe a patient presenting with prodromal febrile illness, followed by a wide infection of the nervous system with transverse myelitis and less severe meningitis, encephalitis and polyradiculopathy. The patient was treated with high-dose corticosteroids, antibiotics and acyclovir; in spite of therapy his condition improved very slowly, with severe neurological sequelae. Material and methods - Antiviral antibodies were searched for in serum and cerebrospinal fluid (CSF) by commercially available ELISA kits. Viral investigations were performed by cell culture isolation and search for viral antigens, and genomic nucleic acids were investigated by polymerase chain reaction (PCR). Results - Virological and serological studies evidenced a primary infection by cytomegalovirus (CMV), possibly responsible for the prodromal illness, persisting in the course of the disease. PCR performed in the peripheral blood mononuclear cells (PBMCs), DNA collected early and in the CSF drawn 30 days after the onset of the disease showed Epstein-Barr virus (EBV) DNA. The serum panel of EBV antibodies was typical of an intercurrent virus reactivation, more than of a primary infection. Conclusion - EBV is known to be highly infectious for the nervous system, in this case of EMR the presence of DNA sequences in the PBMCs and CSF suggests that EBV plays a role in the development of this newly described syndrome.