The Hidden Role of Epstein-Barr Virus in Encephalitis: Case Studies of Diagnostic Dilemmas
Epstein-Barr virus (EBV), typically associated with infectious mononucleosis and various malignancies, is an uncommon cause of encephalitis. The role of EBV in conjunction with other central nervous system (CNS) infections remains unclear, though its detection may provide critical insights into imm...
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| Format: | Article |
| Language: | Bulgarian |
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Bulgarian Society of Neurology
2025-06-01
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| Series: | Българска неврология |
| Online Access: | https://www.nevrologiabg.com/journal/index.php/neurology/article/view/183 |
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| author | Anubhav Bansal Deepak Jain Bharti Yadav |
| author_facet | Anubhav Bansal Deepak Jain Bharti Yadav |
| author_sort | Anubhav Bansal |
| collection | DOAJ |
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Epstein-Barr virus (EBV), typically associated with infectious mononucleosis and various malignancies, is an uncommon cause of encephalitis. The role of EBV in conjunction with other central nervous system (CNS) infections remains unclear, though its detection may provide critical insights into immune status and patient prognosis. This article presents three cases where EBV coexisted with primary CNS infections, complicating diagnostic and treatment processes.
Case 1: A 38-year-old male with a six-month history of intermittent fever, altered sensorium, and seizures was diagnosed with disseminated tuberculosis and EBV encephalitis. Initial MRI of brain suggested viral encephalitis, and CSF analysis revealed Mycobacterium tuberculosis. CSF PCR confirmed EBV, leading to successful treatment with antiepileptics, antitubercular therapy, and acyclovir.
Case 2: A 32-year-old male presented with fever, headache, vomiting, and altered sensorium. CSF analysis showed Streptococcus pneumoniae and EBV. MRI indicated extensive CNS involvement. The patient responded well to antibiotics, acyclovir, and dexamethasone.
Case 3: A 47-year-old female presented with 10 days of fever, severe headache, and 2 days of altered sensorium. Examination revealed meningitis with positive Kernig’s sign. CSF PCR confirmed Mycobacterium tuberculosis and Epstein-Barr virus, and MRI showed leptomeningeal enhancement with infarcts.
She responded well to antitubercular therapy, acyclovir and steroids, and was discharged in a fully conscious and oriented state.
These cases highlight EBV’s potential to exacerbate CNS infections, evidenced by significant MRI changes and diagnostic challenges. Despite its rarity, EBV encephalitis should be considered in differential diagnoses, particularly in immunocompromised individuals. The primary diagnostic tool remains CSF PCR, while treatment efficacy varies, necessitating further research for standardized guidelines.
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| format | Article |
| id | doaj-art-70d234ca51344cc4b42ec2f77ba8cb4f |
| institution | Kabale University |
| issn | 1311-8641 2815-2522 |
| language | Bulgarian |
| publishDate | 2025-06-01 |
| publisher | Bulgarian Society of Neurology |
| record_format | Article |
| series | Българска неврология |
| spelling | doaj-art-70d234ca51344cc4b42ec2f77ba8cb4f2025-08-20T03:46:41ZbulBulgarian Society of NeurologyБългарска неврология1311-86412815-25222025-06-0126110.5281/zenodo.16883817The Hidden Role of Epstein-Barr Virus in Encephalitis: Case Studies of Diagnostic DilemmasAnubhav Bansal0https://orcid.org/0009-0006-9816-2893Deepak Jain1https://orcid.org/0000-0001-9476-3671Bharti Yadav2https://orcid.org/0009-0007-5733-5468Pt. B. D. sharma PGIMS Rohtak IndiaPt. B. D. sharma PGIMS Rohtak indiaPt. B. D. sharma PGIMS Rohtak india Epstein-Barr virus (EBV), typically associated with infectious mononucleosis and various malignancies, is an uncommon cause of encephalitis. The role of EBV in conjunction with other central nervous system (CNS) infections remains unclear, though its detection may provide critical insights into immune status and patient prognosis. This article presents three cases where EBV coexisted with primary CNS infections, complicating diagnostic and treatment processes. Case 1: A 38-year-old male with a six-month history of intermittent fever, altered sensorium, and seizures was diagnosed with disseminated tuberculosis and EBV encephalitis. Initial MRI of brain suggested viral encephalitis, and CSF analysis revealed Mycobacterium tuberculosis. CSF PCR confirmed EBV, leading to successful treatment with antiepileptics, antitubercular therapy, and acyclovir. Case 2: A 32-year-old male presented with fever, headache, vomiting, and altered sensorium. CSF analysis showed Streptococcus pneumoniae and EBV. MRI indicated extensive CNS involvement. The patient responded well to antibiotics, acyclovir, and dexamethasone. Case 3: A 47-year-old female presented with 10 days of fever, severe headache, and 2 days of altered sensorium. Examination revealed meningitis with positive Kernig’s sign. CSF PCR confirmed Mycobacterium tuberculosis and Epstein-Barr virus, and MRI showed leptomeningeal enhancement with infarcts. She responded well to antitubercular therapy, acyclovir and steroids, and was discharged in a fully conscious and oriented state. These cases highlight EBV’s potential to exacerbate CNS infections, evidenced by significant MRI changes and diagnostic challenges. Despite its rarity, EBV encephalitis should be considered in differential diagnoses, particularly in immunocompromised individuals. The primary diagnostic tool remains CSF PCR, while treatment efficacy varies, necessitating further research for standardized guidelines. https://www.nevrologiabg.com/journal/index.php/neurology/article/view/183 |
| spellingShingle | Anubhav Bansal Deepak Jain Bharti Yadav The Hidden Role of Epstein-Barr Virus in Encephalitis: Case Studies of Diagnostic Dilemmas Българска неврология |
| title | The Hidden Role of Epstein-Barr Virus in Encephalitis: Case Studies of Diagnostic Dilemmas |
| title_full | The Hidden Role of Epstein-Barr Virus in Encephalitis: Case Studies of Diagnostic Dilemmas |
| title_fullStr | The Hidden Role of Epstein-Barr Virus in Encephalitis: Case Studies of Diagnostic Dilemmas |
| title_full_unstemmed | The Hidden Role of Epstein-Barr Virus in Encephalitis: Case Studies of Diagnostic Dilemmas |
| title_short | The Hidden Role of Epstein-Barr Virus in Encephalitis: Case Studies of Diagnostic Dilemmas |
| title_sort | hidden role of epstein barr virus in encephalitis case studies of diagnostic dilemmas |
| url | https://www.nevrologiabg.com/journal/index.php/neurology/article/view/183 |
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