Basal ganglia and brainstem encephalitis, optic neuritis, and radiculomyelitis in Epstein–Barr virus infection

Epstein–Barr Virus Neuroretinitis in a Lung Transplant Patient

“…One important strategy for all opportunistic infections is to reduce immunosuppression whenever feasible, although that was not possible in this case. In contrast to our patient’s outcome, the prognosis of EBV optic neuropathy appears to be more favorable in immunocompetent patients, with nearly complete recovery achieved in most individuals without antiviral treatment (6, 7). It is noteworthy that clinical deterioration was slowed in our patient during a course of high-dose systemic steroids.…”

“…EBV-associated optic neuropathy is rare, seen mostly in immunocompetent adults in the setting of infectious mononucleosis (2-7). We evaluated an immunosuppressed patient who developed bilateral EBV neuroretinitis, with subacute swelling of the optic discs, accumulation of intraretinal and subretinal fluid originating from the disc leakage, and finally precipitation of lipid within the neurosensory retina once the fluid resorbed several weeks later (9).…”

“…Ocular manifestations of EBV infection are diverse and include: dacryoadenitis, Parinaud oculoglandular syndrome, follicular conjunctivitis, stromal keratitis, anterior and posterior uveitis, choroioretinitis, optic neuritis, and ophthalmoplegia (1). Optic nerve involvement is particularly rare and has been documented primarily in immunocompetent patients after contracting mononucleosis (2-7). In solid organ transplant patients, EBV is most commonly associated with post-transplant lymphoproliferative disorder (PTLD), a potential fatal complication due to lymphoid proliferation in the setting of immunosuppression (8).…”

Bilateral symmetrical basal ganglia and thalamic lesions in children: an update (2015)

“…Of all the members of the Herpesviridae family, EBV shows the most characteristic tropism for the deep gray nuclei. T2 hyperintensity in the bilateral basal ganglia and thalami is often identified in EBV encephalitis [25][26][27]. Associated anomalies include the cerebral hemispheres, brainstem, and cerebellum [28].…”

“…However, since the description of several adolescent cases and an association with the nvCJD, interest in these rare, slowly progressive and fatal syndromes has increased among pediatricians and the general public [33]. On MRI, basal ganglia alterations in viral and spongiform encephalopathies are most often characterized by restricted diffusion either from primary viral infection or from secondary to virusrelated small vessel vasculopathy and asymmetric involvement of the gray and white matter structures [26,27,32,34]. Lower NAA/Cr has been described in patients affected by sporadic Creutzfeldt-Jakob disease with basal ganglia involvement showing a rapid course of the disease [35].…”