Probable epstein-barr virus encephalitis presenting with status epilepticus in an 8-year-old

CASE REPORTS

Probable Epstein-Barr virus encephalitis presenting with status epilepticus in an 8-year-old

André Salvada¹, Mariana Fidalgo Silva¹, Andreia Filipa Mota¹, Francisca Costa¹, Susana Rocha², Luís Rito Cruz³, Paula Correia¹, Catarina Luís¹.

¹Child and Youth Department, Unidade Local de Saúde de Amadora/Sintra, Amadora, Portugal,
²Pediatrics Department, Unidade Local de Saúde do Arco Ribeirinho, Barreiro, Portugal,
³Neuroradiology Department, Unidade Local de Saúde de Amadora/Sintra, Amadora, Portugal.

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Abstract
Epstein-Barr virus (EBV) infection can lead to complications such as encephalitis, even in immunocompetent individuals.
A previously healthy eight-year-old girl presented with a prodrome of fever, headache, and vomiting. After two days she had a tonic-clonic seizure that evolved to status epilepticus, which resolved with propofol. A diagnosis of probable EBV encephalitis was assumed after detection of EBV DNA in cerebrospinal fluid. Rising copies of EBV DNA were detected in the plasma. Neuroimaging showed focal cortical involvement of the posterior region of the left frontal lobe and of the inferior pole of the ipsilateral temporal lobe. She was treated with acyclovir and showed a full recovery.
EBV encephalitis is a challenging diagnosis due to non-specific clinical manifestations that may significantly overlap with other central nervous system infections.

Why this article important?

In young children most primary Epstein-Barr Virus (EBV) infections are asymptomatic, although they can also lead to various neurological complications, such as encephalitis or meningitis. The clinical presentation of EBV encephalitis tends to be nonspecific and has been associated with a prodrome of fever and headache instead of the constellation of infectious mononucleosis symptoms. Our case illustrates the importance of considering EBV as one of the causative agents of acute encephalitis in young children, regardless of presenting symptoms or immune status. There are currently no standard guidelines for the treatment of EBV encephalitis. Our case also contributes to the evidence base that guides the current discussion on therapeutic approaches in paediatric EBV encephalitis.

Summary of article

Epstein-Barr virus (EBV) infection is usually associated with infectious mononucleosis in teenagers, while most young children are asymptomatic. It can nevertheless lead to various complications, namely meningitis and encephalitis. EBV encephalitis is a challenging diagnosis due to non-specific clinical manifestations that may significantly overlap with other central nervous system infections. We report the case of a school-aged child who developed probable EBV encephalitis with status epilepticus. Our case report discusses the diagnostic challenge associated with this condition as well as possible therapeutic approaches. Cerebrospinal fluid (CSF) PCR supported our diagnosis and is currently the preferred method for establishing a diagnosis. We opted for treatment with acyclovir. The patient showed a full recovery.

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