Autores: DOTT. A. DE MATTEIS, DOTT A. MAIESE, DOTT P. SANTORO, DOTT. Z. DEL FANTE, PROF. V. FINESCHI
Epstein-Barr virus (EBV) is the principal etiological agent of infectious mononucleosis ; neurological complications occur only in about 1-5% of cases but (CSF) pleocytosis is seen in as many as 27% of patients. Meningoencephalitis is the most common neurologic complications related to EBV and in immunocompetent adults is most commonly self-limited.
Material y Métodos
We describe a case of fatal EBV infection characterized by meningoencephalitis, foci of myocarditis and interstitial nephritis in an immunocompetent 74-year-old man who, previously healthy, presented with 1-week history of fatigue and fever, associated with dysarthria, ataxia, hyposthenia of the lower facial muscles and vomiting. The blood tests showed inflammation marker elevation, increase of liver enzymes and white blood cell. His full-body CT scan was unremarkable. He was empirically treated with intravenous steroids and acyclovir but he died few hours late. At the autopsy leptomeninges were increased in thickness and had a whitish color, and 10 cc of clear CSF were taken for microbiological analyses. The organ fragments were fixed in alcohol and formalin. Histological samples processed with H&E staining. Samples showed spread fibroid thickness of leptomeningeal wall with erythrocyte, collected lymphocytes, as well as cells containing brownish pigment in the cytoplasm. The menigoencephalic inflammatory reaction was confirmed by immunohistochemical tests which detected perivasal positivity and within the leptomeningeal layers of the anti-CD45 antibody (pan-leukocyte protein antigen). The CSF protein chain reaction (PCR) was positive for EBV DNA while being negative for other relevant neurotropic viruses. The immunohistochemical analysis showed spots of intracellular positivity to the anti-EBV antibody in brain parenchyma.
The postmortem diagnosis was made based on the presence of EBV- DNA in the cerebrospinal fluid and by immunohistochemical assay that showed spots of intracellular positivity to anti- EBV antibody in brain tissue.
Our case is important both because fatal complications related to EBV in immunocompetent adults are rare and because of the cause of death was identified by careful postmortem evaluation with specific EBV PCR of CSF and immunohistochemical analysis of brain.