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

• Published in: Journal of neurovirology Vol. 10; no. 6; pp. 414 - 417
• Main Authors: Francisci, Daniela, Sensini, Alessandra, Fratini, Daniela, Moretti, Maria Vittoria, Luchetta, Maria Laura, Caro, Antonino Di, Stagni, Giuliano, Baldelli, Franco
• Format: Journal Article
• Language: English
• Published: London Informa UK Ltd 01-12-2004; Taylor & Francis
• Subjects: Adult; Antibodies, Viral - blood; Antibodies, Viral - immunology; Antigens, Viral - immunology; Biological and medical sciences; Brain - pathology; Brain - virology; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; DNA, Viral - analysis; Epstein-Barr Virus Infections - complications; Epstein-Barr Virus Infections - immunology; Epstein-Barr Virus Infections - pathology; Fatal Outcome; Herpesvirus 4, Human - immunology; Human viral diseases; Humans; Immunoglobulin G - blood; Immunoglobulin M - blood; Infectious diseases; Leukoencephalitis, Acute Hemorrhagic - etiology; Leukoencephalitis, Acute Hemorrhagic - pathology; Magnetic Resonance Imaging; Male; Medical sciences; Neurology; Polymerase Chain Reaction; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral diseases of the nervous system; Gammaherpesvirinae; Human; Encephalitis; Nervous system diseases; Herpesviridae; Epstein Barr virus; Hemorrhage; Cerebral disorder; Infection; Virus; immunocompetent man; Viral disease; Central nervous system disease; Young adult; EBV; fatal encephalitis
• ISSN: 1355-0284; 1538-2443
• DOI: 10.1080/13550280490521050

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.