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Encephalomyeloradiculopathy associated with Epstein-Barr virus: primary infection or reactivation?
Introduction:
Encephalomyeloradiculopathy (EMR) is a new syndrome, characterized by extensive involvement of the nervous system at different levels, including brain, medulla and spinal roots. We describe a patient presenting with prodromal febrile illness, followed by a wide infection of the nervous system with transverse myelitis and less severe meningitis, encephalitis and polyradiculopathy. The patient was treated with high-dose corticosteroids, antibiotics and acyclovir; in spite of therapy his condition improved very slowly, with severe neurological sequelae.
Material And Methods:
Antiviral antibodies were searched for in serum and cerebrospinal fluid (CSF) by commercially available ELISA kits. Viral investigations were performed by cell culture isolation and search for viral antigens, and genomic nucleic acids were investigated by polymerase chain reaction (PCR).
Results:
Virological and serological studies evidenced a primary infection by cytomegalovirus (CMV), possibly responsible for the prodromal illness, persisting in the course of the disease. PCR performed in the peripheral blood mononuclear cells (PBMCs), DNA collected early and in the CSF drawn 30 days after the onset of the disease showed Epstein-Barr virus (EBV) DNA. The serum panel of EBV antibodies was typical of an intercurrent virus reactivation, more than of a primary infection.
Conclusion:
EBV is known to be highly infectious for the nervous system, in this case of EMR the presence of DNA sequences in the PBMCs and CSF suggests that EBV plays a role in the development of this newly described syndrome.
Insights
Encephalomyeloradiculopathy (EMR) is a newly identified neurological syndrome. This case study suggests Epstein-Barr virus (EBV) reactivation may play a role in its development, highlighting the need for further research into viral causes of EMR.
Area of Science:
- Neurology
- Virology
- Infectious Diseases
Background:
- Encephalomyeloradiculopathy (EMR) is a recently described neurological syndrome affecting the brain, medulla, and spinal roots.
- This report details a patient with a febrile prodrome followed by extensive central and peripheral nervous system involvement, including transverse myelitis, meningitis, encephalitis, and polyradiculopathy.
Observation:
- The patient presented with a complex neurological illness following a febrile illness.
- Diagnostic investigations included serological tests, viral cultures, and PCR for viral nucleic acids in serum and cerebrospinal fluid (CSF).
Findings:
- Cytomegalovirus (CMV) infection was identified, potentially causing the initial febrile illness.
- Epstein-Barr virus (EBV) DNA was detected in peripheral blood mononuclear cells (PBMCs) and CSF, indicating active infection or reactivation.
Implications:
- The findings suggest a potential role for EBV in the pathogenesis of EMR, a syndrome with severe neurological sequelae.
- Further investigation into viral triggers for EMR is warranted to improve diagnosis and treatment strategies.