Successful Treatment of Epstein–Barr Virus Encephalitis in the Setting of HIV-Associated Neurocognitive Disorder: A Diagnostic and Therapeutic Challenge

Abstract

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.

Biopsy‐proven case of Epstein–Barr virus (EBV)‐associated vasculitis of the central nervous system

“…Only one study has reported a case of chronic active EBV infection with the features of granulomatosis with polyangiitis because it is very rare . Other studies have described encephalitis due to EBV with HIV infection; on the other hand, our case was HIV‐negative, and thus, EBV may have played a more significant role in the development of vasculitis.…”

“…The virus may also cause chronic active EBV infection (CAEBV) characterized by chronic or recurrent infectious mononucleosis (IM)‐like symptoms, abnormal increases in specific anti‐EBV antibodies, and hypersensitivity or skin ulceration caused by mosquito bites . However, there have been no reports of encephalopathy/vasculitis associated with EBV infection, except for rare cases of co‐infection by human immunodeficiency virus (HIV) . We herein report the first case of EBV infection involving encephalopathy and vasculitis without HIV infection.…”

“…2 However, there have been no reports of encephalopathy/vasculitis associated with EBV infection, except for rare cases of co-infection by human immunodeficiency virus (HIV). [3][4][5][6][7][8] We herein report the first case of EBV infection involving encephalopathy and vasculitis without HIV infection.…”

Características clínicas, etiología, tratamiento y evolución de la epilepsia refractaria en la infancia

“…La infección por VEB puede producir complicaciones neurológicas, como meningitis, encefalitis, mielorradiculitis, síndrome de GuillainBarré o encefalomielitis aguda diseminada [131][132][133][134], que se observan en el 0,7-7,3% de todos los casos [131,135], siendo la meningoencefalitis el cuadro neurológico más descrito [136]. En pacientes afectos de virus de la inmunodeficiencia humana (VIH), se ha relacionado con frecuencia la infección por VEB con el linfoma cerebral primario del sistema nervioso central [135]. La encefalitis por VEB es una complicación grave poco frecuente en pacientes VIH inmunodeprimidos que se debe investigar ante pacientes con clínica neurológica [137].…”

“…No se pudo realizar la PCR cuantitativa en nuestro laboratorio. Como opciones terapéuticas en el tratamiento antiviral de la encefalitis por VEB se han empleado aciclovir, valaciclovir o ganciclovir, y no se han encontrado diferencias entre ellos [131,[134][135]. Nuestra paciente presentó una mejoría significativa tras el tratamiento.…”