Meningoencephalitis Caused by Epstein-barr Virus in Adult with Lung Tuberculosis

Abstract

Epstein-Barr virus (EBV) infections usually cause mild symptoms and resolves spontaneously, however the virus may cause severe complications such as neurological diseases, malignant diseases and myocarditis. Determining a diagnosis requires molecular, serological and imaging procedures. The therapeutic modalities for EBV-related severe organ damage including central nervous system manifestations are still uncertain. We report a 31-year-old man with lung tuberculosis with EBV meningoencephalitis presenting with prolonged fever and altered consciousness. Cranial imaging was consistent with meningoencephalitis characteristics. The diagnosis was made by EBV-DNA amplification in cerebrospinal fluid samples. In this case report, we aim to describe a meningoencephalitis caused by EBV in adult with underlying other organ infection.have antibodies to the virus [1,2]. Central nervous system (CNS) involvement in primary EBV infection in adults is rare, with less than 8% of cases found. EBV was found as a causative agent in 2 to 5% of viral encephalitis and meningitis cases [3].Involvement of EBV in CNS includes encephalitis, meningitis, cerebellitis, myelitis, plexitis and acute disseminated encephalomyelitis [2,[4][5][6]. This case report aims to describe a patient with lung tuberculosis showing symptoms and signs of meningoencephalitis caused by EBV. Case ReportA 31-year-old man was admitted to the emergency room with a history of unconsciousness since the day before admission. He previously had 6 days of fluctuating fever and headache. The patient had some behavioral changes since six days before admission such as deliriousness, incoherence and anxiousness. There were involuntary movements in both his hands. He was diagnosed with miliary type lung tuberculosis (TB) 3 months ago. He was given a regimen of antituberculosis drugs which he consumed for only two months before stopping for one month.On admission, he was sopor (Glasgow Coma Scale E2M5V2) and his vital signs recorded were blood pressure 110/70 mmHg, heart rate 70x/minute, respiratory rate 32x/minute, and temperature 37oC. There was crackles in right lung examination. In the neurologic examination there was nuchal rigidity, positive Kernig sign, hemiparesis in right extremities, and positive Babinski sign.Initial investigations including hematologic, liver function, renal function and random plasma glucose did not show any abnormalities, except for a decrease in serum sodium 123 mmol/L. Anti-HIV test was negative, with normal CD4 count, CD 8 count and CD4:CD8 ratio. Serology test for syphilis were normal. Blood culture was negative for bacteria.The chest X-ray revealed no abnormality at this admission. Contrast-enhanced CT scan conducted on admission was consistent with meningoencephalitis characteristics and hydrocephalus sign was noted. He was diagnosed with TB meningoencephalitis and lung tuberculosis with history incompliance to TB therapy. He was treated with ceftriaxone, the same antituberculosis drug regimen and dexamethasone therapy with tapering...