Acute Epstein-Barr virus encephalitis in an immunocompetent adolescent patient

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].

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).

• References

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