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Epstein-Barr Virus—Associated Meningoencephalomyelitis: Intrathecal Reactivation of the Virus in an Immunocompetent Child

Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Shouichi Ohga, MD, PhD

Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, ohgas{at}pediatr.med.kyushu-u.ac.jp

Ryutaro Kira, MD, PhD

Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Akihiko Nomura, MD, PhD

Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Hiroyuki Torisu, MD, PhD

Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Hidetoshi Takada, MD, PhD

Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Koichi Kusuhara, MD, PhD

Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Toshiro Hara, MD, PhD

Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Neurologic complications, including meningoencephalitis, transverse myelitis, and peripheral neuropathy, have been reported in patients with acute infectious mononucleosis. Chronic active Epstein-Barr virus and human immunodeficiency virus infections occasionally induce central nervous system lymphoma. On the other hand, central nervous system disease alone associated with Epstein-Barr virus rarely occurs in previously healthy individuals. A 15-year-old girl who developed acute disseminated encephalomyelitis-like disease presenting fever, anuresis, diplopia, and muscle weakness is described here. Clinical and neuroimaging studies led to the diagnosis of encephalomyelitis. Despite the absence of infectious mononucleosis-like symptoms, anti-Epstein-Barr virus antibody titers in serum and cerebrospinal fluid showed the virus reactivation. The copy number of Epstein-Barr virus DNA increased in cerebrospinal fluid but not in peripheral blood. Ganciclovir and repeated methyl-prednisolone pulse therapy resulted in complete resolution. Central nervous system disease on the limited intrathecal reactivation of Epstein-Barr virus in immunocompetent children should be differentiated from acute disseminated encephalomyelitis.

Key Words: Epstein-Barr virus • meningoencephalomyelitis • acute disseminated encephalomyelitis

Journal of Child Neurology, Vol. 23, No. 9, 1072-1077 (2008)
DOI: 10.1177/0883073808315414


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