EBV meningoencephalitis accompanied with multifocal cerebral lesions

Background

Meningoencephalitis causes the considerable morbidities among the affected individuals. There are only a few detailed descriptions about the diffusion-weighted images of Epstein Barr virus (EBV) meningoencephalitis. Furthermore, the systemic involvement of the EBV in such cases has not been reported yet.

Results

A 30-year-old man was admitted to the hospital with fever, headache, and meningismus. Despite the initial findings of spinal fluid examination supporting a bacterial origin, he showed no therapeutic response to the adequate antibiotics treatment and started to complain of the respiratory difficulty, due to bronchopneumonia. On the additional laboratory examinations, brain MRI FLAIR showed multifocal patchy high signal lesions in the both subcortical white matters, right corpus callosum genu, left temporal subcortical areas, which were shown high signal intensities on the apparent diffusion coefficient. The hepatomeagaly and azotemia were noted. The EBV viral DNA was detected in the peripheral blood mononucleated cells and in the CSF extracts. He was commenced with the ganciclovir, thereafter, his symptoms were subsided and he discharged without any neurologic sequelae.

Conclusion

We describe the case of EBV meningoencephalitis accompanied with multifocal cerebral parenchymal lesions with vasogenic edema. Hepatomegaly, azotemia, and bronchopneumonia were also noted. This report can enrich the clinical data about the atypical meningoencephalitis caused by EBV, and helps to decide the initial diagnostic approach and the treatment strategies.