Epstein-Barr Virus Infection associated Transverse Myelitis with Brain Involvement in an Immunosuppressed Patient: A Case Report.
10.26815/jkcns.2017.25.4.277
- Author:
Youngkyu SHIM
1
;
Hunmin KIM
;
Hee HWANG
;
Jong Hee CHAE
;
Jieun CHOI
;
Ki Joong KIM
;
Ki Joong LIM
Author Information
1. Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea. prabbit7@snu.ac.kr
- Publication Type:Case Report
- Keywords:
Epstein-Barr virus;
Acute transverse myelitis;
Immunocompromised patient
- MeSH:
Acyclovir;
Anal Canal;
Brain*;
Central Nervous System;
Cerebral Cortex;
Cerebrospinal Fluid;
Demyelinating Diseases;
DNA;
Epstein-Barr Virus Infections;
Female;
Follow-Up Studies;
Glycogen Storage Disease;
Herpesvirus 4, Human*;
Humans;
Immunocompromised Host;
Immunoglobulins;
Immunosuppressive Agents;
Leukocytosis;
Liver Transplantation;
Lower Extremity;
Magnetic Resonance Imaging;
Methylprednisolone;
Myelitis, Transverse*;
Optic Nerve;
Reflex, Stretch;
Spinal Cord;
Tacrolimus;
Upper Extremity;
Viral Load;
Young Adult
- From:
Journal of the Korean Child Neurology Society
2017;25(4):277-280
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
A 19-year-old girl with immunosuppressive agents of tacrolimus and mychophenolate mofetil following liver transplantation due to glycogen storage disease visited hospital due to lower extremity motor weakness and blurred vision. Motor power was checked as grade II in the upper extremities and grade 0 in the lower extremities with absence of deep tendon reflexes and anal sphincter dysfunction. The magnetic resonance imaging (MRI) showed increased T2 high signal intensity lesions from C4 to L2 level of spinal cord, cerebral cortex, and the left optic nerve. The cerebrospinal fluid (CSF) analysis showed pleocytosis. Epstein-Barr virus (EBV) deoxyribonucleic acid (DNA) was detected as 5,954 copies/mL in CSF whereas all other microbiologic tests were negative. Anti-aquaporin 4 antibody and oligoclonal band were not detected. Intravenous immunoglobulin, methylprednisolone pulse therapy and 3-week course of acyclovir were administered. Although motor power in the upper extremities recovered to grade V, motor power in the lower extremities did not show any improvement. The EBV viral load was not detected in the follow-up CSF examination. EBV infection in an immune-compromised patient could cause extensive demyelinating diseases in central nervous system and result in severe disability.
