Journal Article

Primary Epstein-Barr virus infection in immunocompetent patients with acute transverse myelitis and a combination of polyradiculitis and anterior horn syndrome as neurological manifestations

Battjes, Suzanne, de Kruijk, Jelle R, Poorthuis, Michiel H F, Dorigo-Zetsma, J Wendelien

2018

Overview

Neurological manifestations of a primary Epstein-Barr virus (EBV) infection are rare. We describe a case with acute transverse myelitis and another case with a combination of polyradiculitis and anterior horn syndrome as manifestations of a primary EBV infection.The first case is a 50-year-old immunocompetent male diagnosed with acute transverse myelitis, 2 weeks after he was clinically diagnosed with infectious mononucleosis. The second case is an 18-year-old immunocompetent male diagnosed with a combination of polyradiculitis and anterior horn syndrome while he had infectious mononucleosis. The first patient was treated with methylprednisolone. After 1 year, he was able to stop performing clean intermittent self-catheterisation. The second patient completely recovered within 6 weeks without treatment.Primary EBV infection should be considered in immunocompetent patients presenting with acute transverse myelitis and a combination of polyradiculitis and anterior horn syndrome. Antiviral treatment and steroids are controversial, and the prognosis of neurological sequelae is largely unknown.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adolescent / Animal bites / Ankle / Antibodies / Antigens / Antiviral Agents - therapeutic use / Antiviral drugs / Bone marrow / Case reports / Cytomegalovirus / Diagnosis, Differential / Electrolytes / Epstein-Barr virus / Epstein-Barr Virus Infections - complications / Epstein-Barr Virus Infections - diagnosis / Epstein-Barr Virus Infections - diagnostic imaging / Epstein-Barr Virus Infections - drug therapy / Fecal incontinence / Hemoglobin / Hepatitis / Herpes viruses / HIV / Human immunodeficiency virus / Humans / Immunocompetence / Immunoglobulins / infection (neurology) / Infections / infectious diseases / Inflammatory diseases / Laboratories / Leukocytes / Liver / Lymphocytes / Male / Medical diagnosis / Meningitis / Middle Aged / Mononucleosis / Motor Neuron Disease - complications / Motor Neuron Disease - diagnosis / Motor Neuron Disease - diagnostic imaging / Motor Neuron Disease - drug therapy / Motor neurone disease / Myelitis, Transverse - complications / Myelitis, Transverse - diagnosis / Myelitis, Transverse - diagnostic imaging / Myelitis, Transverse - drug therapy / Nervous system / neurology / Neutrophils / Patients / Phosphatase / Polymerase chain reaction / Polyradiculopathy - complications / Polyradiculopathy - diagnosis / Polyradiculopathy - diagnostic imaging / Polyradiculopathy - drug therapy / Serology / Spinal cord / Spleen / Syndrome / Tomography, X-Ray Computed / Transplants & implants / Unusual Association of Diseases/Symptoms