| Abstrakt: |
INTRODUCTION/OBJECTIVES: Epstein-Barr virus usually causes mild and self-limiting infections in children and adolescents. Infectious mononucleosis is the most common clinical manifestation but neurologic complications, such as encephalitis, occur in up to 8% of patients. CASE PRESENTATION: A 10-year-old girl was admitted with fever persisting for 6 days, GAS negative acute tonsillopharyngitis and decreased level of consciousness. Shortly after admission, she suffered a tonic seizure that progressed to refractory status epilepticus. To control the seizure, she was treated with levetiracetam and had to be placed in a barbiturate coma. Laboratory results suggested acute mononucleosis and serology confirmed a primary EBV infection with positiveIgM VCA (viral capsid antigen) and EA (early antigen) antibodies. Cerebrospinal fluid analysis revealed mild lymphocyte pleocytosis (25 cells/μl) but negative EBV antibodies. EBV DNA was detected in the blood using PCR (56 000 EBV copies/ml). Her EEG was abnormal with diffuse slowing and irregular wave patterns, while brain MRI showed cortical oedema and subcortical hyperintensities in the T2 sequence characteristic of acute encephalitis. Other common bacterial and viral causes of encephalitis were excluded. Shewas treated with intravenous acyclovir for EBV infection, received intravenous immunoglobulins, and started on methylprednisolone. Her neurologic status, motor, and cognitive functions improved, and she was discharged with only discrete neurocognitive impairments. CONCLUSION: EBV can cause a variety of neurologiccomplications. Our patient had a rare form of severe encephalitis during primary EBV infection presenting with refractory status epilepticus. These neurologic complications may also be immunologically mediated or occur during reactivations of the virus. [ABSTRACT FROM AUTHOR] |
