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Epstein-Barr virus--associated acute autonomic neuropathy
J L Bennett1, R Mahalingam, M C Wellish
1Department of Neurology, University of Colorado Health Sciences Center, Denver 80262, USA.
Annals of Neurology
|September 1, 1996
Summary
A febrile illness triggered acute autonomic neuropathy in a 44-year-old man, characterized by vision problems and sensory issues. Cerebrospinal fluid analysis confirmed Epstein-Barr virus (EBV) infection, marking the first such documented case.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Autonomic neuropathies are a diverse group of disorders affecting the autonomic nervous system.
- Small fiber neuropathies, particularly those impacting autonomic function, can present with a wide range of symptoms.
- Epstein-Barr virus (EBV) is a common human herpesvirus with known associations with various neurological complications.
Observation:
- A 44-year-old male presented with acute onset of blurry vision, photosensitivity, orthostasis, constipation, and acrodysesthesias following a febrile illness.
- Neurologic examination and ancillary studies indicated a diagnosis of dysautonomic small fiber neuropathy.
- The patient's symptoms significantly impacted his quality of life and daily functioning.
Findings:
- Cerebrospinal fluid (CSF) analysis revealed the presence of both Epstein-Barr virus (EBV) DNA and specific antibodies against EBV.
- This finding provides direct evidence of active EBV infection within the central nervous system in the context of autonomic neuropathy.
- The combination of clinical presentation and laboratory results strongly implicates EBV as the causative agent.
Implications:
- This case represents the first documented instance of acute autonomic neuropathy associated with confirmed Epstein-Barr virus infection in the cerebrospinal fluid.
- The findings suggest that EBV should be considered in the differential diagnosis of acute autonomic neuropathies, especially after a febrile prodrome.
- Further research is warranted to elucidate the precise mechanisms by which EBV may trigger or exacerbate autonomic dysfunction and to explore potential therapeutic strategies.