The spectrum of Epstein-Barr virus infections of the central nervous system after organ transplantation

Abstract

Background Epstein-Barr virus (EBV)-related neurologic complications have a diverse presentation in transplant recipients, creating diagnostic and therapeutic challenges for clinicians. In this case series, we report unique manifestations of EBV related neurologic complications following solid organ transplant and highlight pitfalls in management. Case presentations A retrospective search of the electronic medical record of all patients from January 2015 to December 2020 who underwent solid organ transplantation and had central nervous system complications as determined by ICD-10 codes were included. Three patients with unique manifestation of EBV-related neurologic complications after liver transplantation were identified. The first was a 52-year-old man with a live-donor liver transplant 11 years prior for Budd-Chiari syndrome presented with several weeks of headache and several lesions on brain MRI; he was diagnosed with primary central nervous system post-transplant lymphoproliferative disorder. The second patient was a 63-year-old man with a deceased-donor liver transplant 16 years prior for alpha-1-antitrypsin deficiency and was found to have a stroke; he was diagnosed with EBV encephalitis. The final patient was a 75-year-old woman with a deceased-donor liver transplant six years prior for primary biliary cirrhosis who presented with four months of gait instability; she was diagnosed with EBV myelitis. A review of the literature was performed to supplement description of the different diseases. Conclusions EBV-related central nervous infection in post-transplant patients can manifest in a variety of neurologic syndromes, which can be challenging to diagnose. Careful correlation of clinical, pathologic, and radiologic findings and a high index of suspicion are crucial in identification and appropriate management.

Primary central nervous system post-transplantation lymphoproliferative disorder: A case report and systematic review of imaging findings

“…6 A PRISMA flowchart of our screening and review process. [2 , 3 , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , 38 , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [51] , [52] , [53] , [54] , 57 , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , …”

From bedside to bench: how existing therapies inform the relationship between Epstein–Barr virus and multiple sclerosis

“…These features are similar to CNS post‐transplant lymphoproliferative disorder (PTLD). 41 There is more to be learnt about EBV encephalitis, but no strong indication that EBV is neurotropic, causes demyelination or precedes MS.…”

Prevention of Oncogenic Gammaherpesvirinae (EBV and HHV8) Associated Disease in Solid Organ Transplant Recipients

“…The features of these EBV manifestations may include infective mononucleosis, oral hairy leukoplakia [99], and end-organ infections such as encephalitis/myelitis [100] or hepatitis [101]. Some of these manifestations may share clinical features of PTLD (e.g., encephalitis vs. CNS PTLD).…”