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고용량의 정맥내 면역글로불린 치료 후 호전을 보인Epstein-Barr Virus 감염증에 합병한 뇌염1예

A Case of Epstein-Barr Virus Associated Encephalitis Improved after High-Dose Intravenous Immunoglobulin Therapy

김성원|유황재|장명완
대한감염학회 (The Korean Society Of Infectious Diseases)|2006.08|Infection and Chemotherapy|제38권 제4호|pp. 219-223

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참고문헌

주제분류내과학

초록

저자들은 스테로이드와 acyclovir 치료로 조절되지 않았던 EBV 감염증에 합병한 뇌염 환자에게 Acyclovir, Steroid를 사용하다가 정맥내 면역글로불린을 추가로 투여하여 임상증상 및 뇌자기공명 영상검사에서 병변이 호전된 경우를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Abstract

Neurologic complications of Epstein-Barr virus (EBV) infection are diverse including a number of neurologic diseases such as encephalitis, encephalomyelitis, Guillain-Barre syndrome, optic neuritis, acute disseminated encephalomyelitis, cerebellitis, and Alice-In-Wonderland syndrome. In general encephalitis caused by EBV in children has been considered a self-limited disease with few or no sequelae. Occasionally it leaves a severe neurologic sequela and complications. Therefore administration of high dose acyclovir and steroid in early stages of EBV encephalitis is recommended currently. In this case, the patient of a 8-year-old boy was admitted because of generalized tonic seizure of 2 times. He showed 16% of atypical lymphocytosis in peripheral blood smear and positive findings in VCA-IgM and EA-IgM tests. EBV DNA Antibody, and virus PCR in CSF was not evaluated. He also showed hepatosplenomegaly in abdominal sonography. Brain MRI revealed a bilateral increased signal intensity at lenticular nucleus and caudate nucleus, multiple high signal intensity at cortical layer of both gyrus reti, both frontal, inferior parietal, and dorsal aspect of the right paracentral lobue. As mentioned in serologic and imaging study, he was diagnosed as the EBV- associated encephalitis. Although we administered high dose acyclovir and corticosteroids, he showed clinical deterioration with confusion, delirium, and ataxia. Therefore, we administered additional high dose intravenous immunoglobulin, and finally he was recovered. We report the case of improvement of EBV-associated encephalitis after high-dose Intravenous immunoglobulin therapy.

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