The Spectrum of Epstein-Barr Virus Infections of the Central Nervous System After Organ Transplantation

Abstract

BackgroundEpstein-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 and 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 found to have several lesion on brain MRI who 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 who was found to have a stroke and was diagnosed with EBV encephalitis with vasculitis. 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 and was diagnosed with EBV myelitis. A review of the literature was performed to supplement description of the different diseases. ConclusionsEBV-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.

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“…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.…”