Epstein–Barr virus encephalitis in a renal transplant recipient manifesting as hemorrhagic, ring‐enhancing mass lesions

Abstract

Epstein-Barr virus (EBV) encephalitis has been infrequently described in immunocompromised patients. Here, we report a unique case of biopsy-proven EBV encephalitis in a renal transplant recipient presenting with altered mental status, prominent visual disturbances, and hemorrhagic, ring-enhancing mass lesions on magnetic resonance imaging. The patient was successfully treated with a prolonged course of antivirals. This case illustrates the difficulty in interpretation of cerebrospinal fluid EBV polymerase chain reaction assay, given the lack of specificity in immunocompromised patients.

Epstein–Barr Virus Neuroretinitis in a Lung Transplant Patient

“…This discrepancy between CSF and serum has been encountered previously in cases of EBV-associated PTLD, optic neuritis, and encephalitis (3, 13-15). Potential explanations include the use of two different PCR assays for CSF and serum samples, preferential replication of the virus in the CNS, or presence of PCR inhibitor in the peripheral blood.…”

Relapsing EBV encephalitis in a renal transplant recipient

“…Neurologic sequelae of EBV infection are due to the virus-host immunity interaction, and include encephalitis, meningitis, cerebellitis, polyradiculomyelitis, transverse myelitis, and cranial and peripheral neuropathies [2], [6]. Outside of primary EBV infection, reactivation of latent virus is a prerequisite for CNS involvement and is most likely to occur in T-cell immunosuppressed hosts [1], [2], [7], [8], [9]. In the current case, donor derived primary EBV infection is most likely, given the sero-discordance at time of transplantation.…”

“…Both acyclovir and ganciclovir target the viral DNA-polymerase, potentially halting active EBV infection. Valganciclovir would be the preferred drug of choice, given its ten-fold increased in-vitro activity against EBV compared to valacyclovir [9], [18]. Myelosuppression may occur after prolonged valganciclovir treatment.…”

Fulminant Epstein–Barr virus‐associated hemophagocytic syndrome in a renal transplant patient and review of the literature

“…Neither of them is specific against EBV infection and possibly there is no apparent antiviral activity superiority between these 2 antiviral agents against EBV (20). However, a few case reports of severe EBV infections describe successful outcome from treatment with acyclovir (21,22), ganciclovir (23,24), or both (25,26). Had the clinical course of our patient not progressed in such a fulminant and atypical manner, addition of chemotherapeutic agents to corticosteroids might have been considered, according to the latest therapeutic protocols, such as etoposide or rituximab, a monoclonal antibody targeting the CD20 molecule, whose administration has shown clinical benefit in certain refractory cases (27)(28)(29).…”