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[Encephalitis in a renal transplantation patient]
1Servicio de Nefrología, Hospital de Cruces, Baracaldo, Vizcaya. soniada@euskalnet.net
Summary
A kidney transplant patient developed severe neurological symptoms due to Epstein-Barr virus (EBV) reactivation. Prompt treatment with ganciclovir led to recovery, demonstrating the importance of early diagnosis and antiviral therapy for EBV neurological disease.
Area of Science:
- Nephrology
- Infectious Diseases
- Neurology
Background:
- A 55-year-old female with chronic renal failure received a kidney allograft.
- Preoperative serologic tests indicated prior Epstein-Barr virus (EBV) and Cytomegalovirus (CMV) exposure.
- Immunosuppressive therapy included cyclosporine, azathioprine (later mycophenolate mofetil), and steroids.
Observation:
- The patient presented with vertigo, influenza-like symptoms, and later visual hallucinations and impaired consciousness.
- Laboratory findings included leukocytosis, anemia, hyponatremia, and worsening renal failure.
- Cerebrospinal fluid (CSF) analysis revealed pleocytosis with a predominance of polymorphonuclear leukocytes.
Findings:
- Brain MRI showed lesions in the brainstem, thalamus, and periventricular white matter.
- Epstein-Barr virus (EBV) DNA was detected in the CSF via PCR.
- Treatment with ganciclovir resulted in partial recovery of consciousness, resolution of neurological deficits, and reduction of MRI lesions.
Implications:
- This case highlights the risk of EBV reactivation in immunosuppressed transplant recipients presenting with neurological symptoms.
- Early diagnosis of EBV encephalitis through CSF PCR and prompt antiviral treatment are crucial for favorable outcomes.
- Successful management underscores the efficacy of ganciclovir in treating EBV-related neurological complications post-transplant.