Emily Kaminski1, Tse Chiang Chen2, Justin Salerian3
1Tulane University School of Medicine, 2Neurology, Tulane University School of Medicine, 3Tulane University, School Of Medicine, Department of Neurology
Objective:
To highlight a clinical case of viral myelitis secondary to Epstein-Barr Virus infection.
Background:
Myelitis is pathologic inflammation of the spinal cord causing pathway interruption and leading to deficits. Lesions may be caused by direct damage to the CNS from a pathogen or through immunological response. Many etiologies exist, including transverse myelitis, longitudinally extensive transverse myelitis, autoimmune causes, and acute flaccid paralysis. Epstein-Barr virus is classified as a herpes virus and is seen in approximately 85% of adults. Epstein-Barr virus commonly manifests as infectious mononucleosis, with only 5% of cases involving the central nervous system. Among those central nervous system cases, myelitis is rare in healthy patients.
Results:
A healthy 20-year-old male from Italy presented to the emergency department with progressive two-day history of urinary retention and constipation, tingling, weakness and decreased sensation in the lower limbs. Days prior, the patient experienced fever of 100 degrees Fahrenheit and back pain. On exam, vitals were stable. Neurological exam was significant for hypoesthesia below the level of T10 bilaterally, 3/5 strength in lower extremities, and 3+ plantar reflex. Initial serum studies revealed leukocytosis and raised ESR and liver enzymes. An MRI pan-spine with and without contrast revealed longitudinally extensive grey matter predominant, non-enhancing T2 hyperintensity from the lower cervical to lower thoracic spine. CSF studies were positive for EBV IgM and IgG antibodies, and EBV DNA. Patient received 5 days of high dose IV steroids and 3 days of IVIG with significant improvement in symptoms, with strength returning to 5/5 in all extremities, resolution of sensation, and reflexes returning to 2+. Although patient still had difficulty ambulating unassisted and required intermittent self-catheterizations, his improvements cleared him from inpatient rehabilitation and was able to be discharged home.
Conclusions:
This case highlights EBV as a rare cause of myelitis in an otherwise young and healthy patient.