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CMV-associated encephalitis and antineuronal autoantibodies--a case report.
Xinling Xu1, Peter Bergman, Thomas Willows
1Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
BMC Neurology
|September 6, 2012
Summary
Primary human cytomegalovirus (CMV) infection in a patient with a rudimentary spleen caused severe encephalopathy. Prompt treatment with antivirals, steroids, and IVIg led to near-complete recovery, highlighting the importance of early intervention.
Area of Science:
- Neurology
- Immunology
- Infectious Diseases
Background:
- Human cytomegalovirus (CMV) is a common pathogen that can dysregulate the host immune system, leading to autoimmune conditions.
- Primary CMV infection can present with severe neurological complications, including encephalopathy.
Observation:
- A 33-year-old woman with a rudimentary spleen presented with encephalitis progressing to a catatonic state.
- Diagnosis of primary CMV infection was confirmed via sensitive assays and CMV DNA in CSF.
- Antineuronal autoantibodies targeting GAD-positive neurons were detected.
Findings:
- The patient's rudimentary spleen may have contributed to the severe course of CMV infection.
- Treatment with prednisone, IVIg, and antivirals resulted in significant neurological improvement.
- One-year follow-up showed near-complete recovery with residual attention and memory deficits.
Implications:
- This case underscores the potential for CMV to trigger autoimmune responses leading to encephalopathy.
- Early and aggressive treatment is crucial for managing severe primary CMV infections with immunopathological manifestations.
- The role of splenic function in modulating CMV severity warrants further investigation.
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