[Successful treatment of Epstein-Barr virus-related encephalomyelitis with steroid and ganciclovir]

We report a 56-year-old man with encephalomyelitis due to Epstein-Barr virus (EBV). The patient suffered from fever and headache, and become somnolent on day 10. On day 18, following treatment with an antibiotic and aciclovir, a cerebrospinal fluid (CSF) examination revealed increased protein levels and lymphocytic pleocytosis. On day 25, he developed progressive tetraplegia, hypesthesia of Th l0 dermatomes, difficulty in defecating, and urinary retention. Magnetic resonance (MR) T2-weighted images showed a high-signal lesion in the center of the medulla oblongata, patchy high-signal lesions throughout the spinal cord, and swelling of the cervical spinal cord. A polymerase chain reaction test for EBV DNA in the CSF was positive. After treatment with high-dose methyl-predonisolone, the neurological symptoms improved rapidly and the high-signal lesions in the spinal cord improved. EBV DNA in the CSF was not detected after treatment with ganciclovir. This case suggests that steroid and ganciclovir are effective for the treatment of EBV-related encephalomyelitis.