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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(07): 489-490
DOI: 10.1590/0004-282X20170080
IMAGES IN NEUROLOGY

Acute Epstein-Barr virus encephalitis in an immunocompetent adolescent patient

Encefalite aguda por virus Epstein-Barr em um paciente adolescente imunocompetente
Rodolfo Mendes Queiroz
1   Hospital São Lucas, MED - Medicina Diagnóstica, Radiologia e Diagnóstico por Imagem, Ribeirão Preto SP, Brasil;
,
Lara Zupelli Lauar
2   Universidade de São Paulo; Faculdade de Medicina de Ribeirão Preto; Hospital das Clínicas, Radiologia e Diagnóstico por Imagem, Ribeirão Preto SP, Brasil.
,
Cecília Hissae Miyake
1   Hospital São Lucas, MED - Medicina Diagnóstica, Radiologia e Diagnóstico por Imagem, Ribeirão Preto SP, Brasil;
2   Universidade de São Paulo; Faculdade de Medicina de Ribeirão Preto; Hospital das Clínicas, Radiologia e Diagnóstico por Imagem, Ribeirão Preto SP, Brasil.
,
Lucas Giansante Abud
1   Hospital São Lucas, MED - Medicina Diagnóstica, Radiologia e Diagnóstico por Imagem, Ribeirão Preto SP, Brasil;
2   Universidade de São Paulo; Faculdade de Medicina de Ribeirão Preto; Hospital das Clínicas, Radiologia e Diagnóstico por Imagem, Ribeirão Preto SP, Brasil.
,
Rafael Gouvêa Gomes de Oliveira
1   Hospital São Lucas, MED - Medicina Diagnóstica, Radiologia e Diagnóstico por Imagem, Ribeirão Preto SP, Brasil;
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A previously-healthy 16-year-old male presented with fever, headache, lethargy and seizures for a day. A hemogram showed mild lymphocytosis. Spinal fluid analysis revealed 75 leukocytes/mm3 (62% neutrophils, 35% lymphocytes, 3% monocytes) and no growth of micro-organisms in culture. Cerebral imaging studies showed an abnormal bilateral symmetrical appearance of the basal ganglia, which, together with positive IgG and IgM serology for the Epstein-Barr virus, suggested acute encephalitis by this agent ([Figure]). Some of the differential diagnoses were: hypoglycemia, hypoxia, intoxication (methanol, carbon monoxide, cyanide), herpes simplex infection, infantile bilateral striatal necrosis and central extrapontine myelinolysis[1],[2],[3],[4],[5].

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Figure A and B. Computed tomography without administration of intravenous contrast showing the basal ganglia bilaterally ill-defined and discreetly hypodense compared to the cerebral cortex. Figures C, D, E and F. Magnetic resonance imaging of the brain show hyperintense basal ganglia bilaterally on T2-weighted sequence (C) and FLAIR (D), hypointense on T1 and without enhancement after administration of intravenous paramagnetic agent (E and F).


Publikationsverlauf

Eingereicht: 21. September 2016

Angenommen: 15. April 2017

Artikel online veröffentlicht:
05. September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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