Acute fatal necrotizing hemorrhagic encephalitis caused by Epstein-Barr virus in a young adult immunocompetent man

Abstract

Epstein-Barr Virus (EBV) encephalitis is a rare (<1%) and generally self-limited disease with few sequelae. This neurological complication has been reported almost exclusively in the course of acute primary infection and in paediatric patients. We describe a case of a young adult immunocompetent man who developed an acute fatal necrotizing haemorrhagic encephalitis as the only manifestation of an acute EBV infection. EBV-DNA was tested positive in several CSF samples by qualitative and quantitative PCR. Serological profile showed: absence of IgM against Viral Capsid Antigen (VCA) in three different consecutive samples, presence of IgG against VCA and IgG seroconversion for Epstein Barr Nuclear Antigen (EBNA). EBV-DNA was detected by qualitative PCR in autoptic brain material. Clinical course was not influenced by antiviral therapy with acyclovir. In conclusion to our knowledge, this is the only case of acute necrotizing haemorrhagic EBV encephalitis with a fatal outcome, in an adult immunocompetent man.

Hemorrhagic encephalitis associated with Epstein-Barr virus infection

“…6,7 To our knowledge there is only previous report of acute hemorrhagic EBV encephalitis in an adult patient. 8 …”

Inmunohistoquímica en un caso de encefalitis por virus de Epstein Barr

“…Los estudios histológicos del SNC en la encefalitis por VEB han contribuido para comprender su patogénesis. Los principales patrones histopatológicos de la encefalitis asociado al VEB son: EMDA, encefalitis con infiltrados mononucleares peri-vasculares y encefalitis hemorrágica edematosa [13][14][15] .…”

Postpartum Lady with Bleed in the Brain: A Rare Manifestation of Neuroleptospirosis with Acute Haemorrhagic Leucoencephalitis (AHLE)

“…It has been proposed that presence of immune cross-reactivity between myelin basic protein moieties and various infectious agent antigens causing the demyelination. Two prior case reports by Befort and Francisci [3,4] presented two cases of AHLE after Epstein-Barr virus infection.…”