A Case of Brainstem Encephalitis Associated with Epstein-Barr Virus Infection
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초록
7세 남아에서 발생한 EBV 재활성화 감염과 연관된 뇌간 뇌염 1례를 보고한다. 환아는 임상증상, 뇌척수액 검사, 그리고 뇌 MRI 검사를 통하여 뇌간 뇌염이 진단 되었고, 임상경과와 관련하여 추적관찰 기간 동안 시행한 EBV 혈청학적 검사들을 통해 EBV 재활성화를 진단하였으며, 임상경과에 있어서 좋은 예후를 보였다. 뇌 MRI 검사상 뇌간 병변은 환아의 회복기에 처음 발견됨으로써 임상경과와 뇌 MRI의 불일치 소견을 보였으며, 병변을 확인하기 위한 뇌 MRI 검사의 반복시행이 필요할 수 있음을 시사 하였다. 또한 ADC MRI 검사상 뇌간 병변은 혈관성 부종소견을 보였고, EBV에 대한 뇌척수액 PCR상 음성소견을 보인 것을 토대로 EBV 재활성화와 관련된 자가면역 기전이 환아의 뇌간 뇌염 발생에 관여하고 있을 것으로 생각된다.
Abstract
A case of brainstem encephalitis associated with a reactivated infection of Epstein- Barr virus (EBV) in a 7-year-old boy is reported. The patient was diagnosed based on the compatible clinical, cerebrospinal fluid and radiological findings and the serological results for EBV, had a favorable clinical course and showed a discrepancy between the course of the neurological features and the evolution of the imaging alterations. The apparent diffusion coefficient imaging revealed the brain stem lesion suggesting an autoimmune mechanism in the pathogenesis of the illness.
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