A Case of Epstein-Barr Virus-associated Brainstem Encephalitis Presenting with Sixth Cranial Nerve Palsy in a Child
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Brainstem encephalitis caused by Epstein-Barr virus (EBV) is rare in childhood. We describe a 14-month-old-boy who presented with limitation of eye movements with sixth cranial nerve palsy. Brainstem encephalitis caused by EBV was diagnosed, based on the neuroimaging and cerebrospinal fluid (CSF), serological examination for EBV infection. Brain magnetic resonance imaging (MRI) showed high signal intensity in T2 and low signal intensity in T1 in both pons and medulla. The result of EBV polymerase chain reaction (PCR) of the CSF was positive, and a serological test showed a convalescent phase of primary infection: positive for viral capsid antigen (VCA)-IgM, VCA-IgG and EBV nuclear antigen (EBNA)-IgG, negative for heterophil antibody. We suggest that EBV infection should be considered a differential diagnosis cause of pediatric brainstem encephalitis and emphasizes the need for immediate diagnosis and initiation of symptomatic and specific therapy.
Abstract
Brainstem encephalitis caused by Epstein-Barr virus (EBV) is rare in childhood. We describe a 14-month-old-boy who presented with limitation of eye movements with sixth cranial nerve palsy. Brainstem encephalitis caused by EBV was diagnosed, based on the neuroimaging and cerebrospinal fluid (CSF), serological examination for EBV infection. Brain magnetic resonance imaging (MRI) showed high signal intensity in T2 and low signal intensity in T1 in both pons and medulla. The result of EBV polymerase chain reaction (PCR) of the CSF was positive, and a serological test showed a convalescent phase of primary infection: positive for viral capsid antigen (VCA)-IgM, VCA-IgG and EBV nuclear antigen (EBNA)-IgG, negative for heterophil antibody. We suggest that EBV infection should be considered a differential diagnosis cause of pediatric brainstem encephalitis and emphasizes the need for immediate diagnosis and initiation of symptomatic and specific therapy.
참고문헌 (17)
- Sumaya CV, "Seroepidemiologic study of Epstein-Barr virus infections in a rural community", J Infect Dis, 131, pp.403~408 (1975)
- Connelly KP, "Neurologic complications of infectious mononucleosis", Pediatr Neurol, 10, pp.181~184 (1994)
- Kamei S, "Nationwide survey of the annual prevalence of viral and other neurological infections in Japanese inpatients", Intern Med, 39, pp.894~900 (2000)
- Doja A, "Pediatric Epstein-Barr Virus-Associated Encephalitis: 10-Year Review", J Child Neurol, 21, pp.384~391 (2006)
- Hung KL, "Epstein-Barr virus encephalitis in children", Acta Paediatr Taiwan, 41, pp.140~146 (2000)
- Corssmit EPM, "Severe neurological complications in association with Epstein-Barr virus infection", J Neurovirol, 3, pp.460~464 (1997)
- North K, "Brain-stem encephalitis caused by Epstein-Barr virus", J Child Neurol, 8, pp.40~42 (1993)
- Bhatti N, "Encephalitis due to Epstein-Barr virus", J Infect, 20, pp.69~72 (1990)
- Kleines M, "Expanding the spectrum of neurological disease associated with Epstein-Barr virus activity", Eur J Clin Microbiol Infect Dis, 30, pp.1561~1569 (2011)
- Baskin HJ, "Neuroimaging of herpesvirus infections in children", Pediatr Radiol, 37, pp.949~963 (2007)
- Häusler M, "Neurological complications of acute and persistent Epstein-Barr virus infection in paediatric patients", J Med Virol, 68, pp.253~263 (2002)
- Straus SE, "NIH conference. Epstein-Barr virus infection: biology, pathogenesis and management", Ann Intern Med, 118, pp.45~58 (1993)
- Gärtner BC, "Evaluation of four commercially available Epstein-Barr virus enzyme immunoassays with an immunofluorescence assay as the reference method", Clini Diagn Lab Immunol, 10, pp.78~82 (2003)
- Grose C, "Primary Epstein-Barr virus infections in acute neurologic diseases", N Engl J Med, 292, pp.392~395 (1975)
- DeBiasi RL, "Use of PCR for the diagnosis of herpesvirus infections of the central nervous system", J Clin Virol, 25(Suppl 1), pp.S5~S11 (2002)
- Anderson J, "Management of Epstein Barr virus infection", Am J Med, 85, pp.107~115 (1998)
- Sumaya CV, "Epstein-Barr virus infectious mononucleosis in children. I. Clinical and general laboratory findings", Pediatrics, 75, pp.1003~1010 (1985)