Successful Treatment of Epstein–Barr Virus Encephalitis in the Setting of HIV-Associated Neurocognitive Disorder: A Diagnostic and Therapeutic Challenge
Free accessCase reportFirst published online February, 2013
Successful Treatment of Epstein–Barr Virus Encephalitis in the Setting of HIV-Associated Neurocognitive Disorder: A Diagnostic and Therapeutic Challenge
We report a challenging case of HIV-associated neurocognitive disorder with superimposed Epstein–Barr virus (EBV) encephalitis. The patient presented with an abnormal MRI brain scan, and EBV DNA that was detected in the cerebrospinal fluid and brain biopsy, which also demonstrated histopathological findings consistent with the diagnosis. This occurred on the background of a 12-month period of gradual cognitive decrease secondary to HIV-associated dementia. Invasive testing was required to reach the diagnosis in this case, highlighting the importance of thorough investigation of neurological impairment in HIV-positive patients. Clinicopathological recovery was achieved through optimization of antiretroviral therapy and use of valganciclovir.
References
1.
MorrisM.C., EdmundsW.J., HeskethL.M.Seroepidemiological patterns of Epstein-Barr and herpes simplex (HSV-1 and HSV-2) viruses in England and Wales. J Med Virol2002; 67: 522–527.
2.
SilversteinA., SteinbergG., NathansonM.Nervous system involvement in infectious mononucleosis. The heralding and-or major manifestation. Arch Neurol1972; 26: 353–358.
3.
CinqueP., VagoL., DahlH.Polymerase chain reaction on cerebrospinal fluid for diagnosis of virus-associated opportunistic diseases of the central nervous system in HIV-infected patients. AIDS1996; 10: 951–958.
4.
MarteliusT., LappalainenM., PalomakiM., AnttilaV.J.Clinical characteristics of patients with Epstein Barr virus in cerebrospinal fluid. BMC Infect Dis2011; 11: 281.
5.
CorcoranC., RebeK., van der PlasH., MyerL., HardieD.R.The predictive value of cerebrospinal fluid Epstein-Barr viral load as a marker of primary central nervous system lymphoma in HIV-infected persons. J Clin Virol2008; 42: 433–436.
6.
IversL.C., KimA.Y., SaxP.E.Predictive value of polymerase chain reaction of cerebrospinal fluid for detection of Epstein-Barr virus to establish the diagnosis of HIV-related primary central nervous system lymphoma. Clin Infect Dis2004; 38: 1629–1632.
7.
WangJ., OzzardA., NathanM.The significance of Epstein-Barr virus detected in the cerebrospinal fluid of people with HIV infection. HIV Med2007; 8: 306–311.
8.
KellyM.J., BenjaminL.A., CartwrightK.Epstein-Barr virus coinfection in cerebrospinal fluid is associated with increased mortality in Malawian adults with bacterial meningitis. J Infect Dis2012; 205: 106–110.
9.
AdamsL.A., DeboerB., JeffreyG., MarleyR., GarasG.Ganciclovir and the treatment of Epstein-Barr virus hepatitis. J Gastroenterol Hepatol2006; 21: 1758–1760.
10.
ChadaideZ., VorosE., HorvathS.Epstein-Barr virus encephalitis mimicking clinical and electroencephalographic characteristics of herpes simplex encephalitis. J Med Virol2008; 80: 1930–1932.
11.
KogelnikA.M., LoomisK., Hoegh-PetersenM., RossoF., HischierC., MontoyaJ.G.Use of valganciclovir in patients with elevated antibody titers against human herpesvirus-6 (HHV-6) and Epstein-Barr virus (EBV) who were experiencing central nervous system dysfunction including long-standing fatigue. J Clin Virol2006; 37Suppl 1: S33–S38.
12.
MacGinleyR., BartleyP.B., SlootsT., JohnsonD.W.Epstein-Barr virus encephalitis in a renal allograft recipient diagnosed by polymerase chain reaction on cerebrospinal fluid and successfully treated with ganciclovir. Nephrol Dial Transplant2001; 16: 197–198.
13.
BossolascoS., FalkK.I., PonzoniM.Ganciclovir is associated with low or undetectable Epstein-Barr virus DNA load in cerebrospinal fluid of patients with HIV-related primary central nervous system lymphoma. Clin Infect Dis2006; 42: e21–e25.
14.
KatramadosA.M., SripathiN., BrarI., MitsiasP.D.Intravenous ganciclovir consistently induces remission of persistent Epstein-Barr encephalitis in an HIV-1-infected patient. AIDS2007; 21: 778–780.
15.
AntinoriA., ArendtG., BeckerJ.T.Updated research nosology for HIV-associated neurocognitive disorders. Neurology2007; 69: 1789–1799.
16.
LetendreS., Marquie-BeckJ., CapparelliE.Validation of the CNS penetration-effectiveness rank for quantifying antiretroviral penetration into the central nervous system. Arch Neurol2008; 65: 65–70.
17.
SacktorN., TarwaterP.M., SkolaskyR.L.CSF antiretroviral drug penetrance and the treatment of HIV-associated psychomotor slowing. Neurology2001; 57: 542–544.
