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Cytomegalovirus-associated encephalomyelitis in an immunocompetent adult: a two-stage attack of direct viral and delayed immune-mediated invasions. case report.
BMC Neurol. 2016 Nov 17; 16(1):223.BN

Abstract

BACKGROUND

It is clinically rare to find cytomegalovirus (CMV)-associated encephalomyelitis in immunocompetent adults. Here, we present the case of an adult patient who developed acute transverse myelitis that was followed by immune-mediated disseminated encephalomyelitis.

CASE PRESENTATION

A 38-year-old man developed acute paraplegia with paresthesia below the level of the T7-8 dermatome. Both brain and spinal cord MRIs performed at admission appeared normal. Corticosteroid therapy was initiated, with the later addition of high-dose intravenous immunoglobulins. After polymerase chain reaction analysis indicated the presence of CMV DNA in his cerebrospinal fluid (CSF), anti-viral therapy was added. Forty days after symptom onset, despite an initial positive response to this therapy, he developed dysarthria and truncal ataxia. Repeated magnetic resonance imaging scans demonstrated progressively expanding lesions involving not only the spinal cord but also the cerebral white matter, suggestive of extensive immune-mediated demyelination involving the central nervous system (CNS), as is observed in acute disseminated encephalomyelitis (ADEM).

CONCLUSION

This case report underscores the importance of careful patient observation following the initial diagnosis of a CMV-associated CNS infection, such as transverse myelitis, on the possibility that post-infectious ADEM may appear.

Authors+Show Affiliations

Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan.Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan.Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan.Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan.Department of Neurology, Juntendo University School of Medicine, 1-21-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan.Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan. hmiwahmiwa@gmail.com.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

27855658

Citation

Daida, Kensuke, et al. "Cytomegalovirus-associated Encephalomyelitis in an Immunocompetent Adult: a Two-stage Attack of Direct Viral and Delayed Immune-mediated Invasions. Case Report." BMC Neurology, vol. 16, no. 1, 2016, p. 223.
Daida K, Ishiguro Y, Eguchi H, et al. Cytomegalovirus-associated encephalomyelitis in an immunocompetent adult: a two-stage attack of direct viral and delayed immune-mediated invasions. case report. BMC Neurol. 2016;16(1):223.
Daida, K., Ishiguro, Y., Eguchi, H., Machida, Y., Hattori, N., & Miwa, H. (2016). Cytomegalovirus-associated encephalomyelitis in an immunocompetent adult: a two-stage attack of direct viral and delayed immune-mediated invasions. case report. BMC Neurology, 16(1), 223.
Daida K, et al. Cytomegalovirus-associated Encephalomyelitis in an Immunocompetent Adult: a Two-stage Attack of Direct Viral and Delayed Immune-mediated Invasions. Case Report. BMC Neurol. 2016 Nov 17;16(1):223. PubMed PMID: 27855658.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cytomegalovirus-associated encephalomyelitis in an immunocompetent adult: a two-stage attack of direct viral and delayed immune-mediated invasions. case report. AU - Daida,Kensuke, AU - Ishiguro,Yuta, AU - Eguchi,Hiroto, AU - Machida,Yutaka, AU - Hattori,Nobutaka, AU - Miwa,Hideto, Y1 - 2016/11/17/ PY - 2016/07/22/received PY - 2016/11/13/accepted PY - 2016/11/19/entrez PY - 2016/11/20/pubmed PY - 2016/12/20/medline KW - Acute disseminated encephalomyelitis KW - Case report KW - Cytomegalovirus KW - Immunocompeten KW - Transverse myelitis SP - 223 EP - 223 JF - BMC neurology JO - BMC Neurol VL - 16 IS - 1 N2 - BACKGROUND: It is clinically rare to find cytomegalovirus (CMV)-associated encephalomyelitis in immunocompetent adults. Here, we present the case of an adult patient who developed acute transverse myelitis that was followed by immune-mediated disseminated encephalomyelitis. CASE PRESENTATION: A 38-year-old man developed acute paraplegia with paresthesia below the level of the T7-8 dermatome. Both brain and spinal cord MRIs performed at admission appeared normal. Corticosteroid therapy was initiated, with the later addition of high-dose intravenous immunoglobulins. After polymerase chain reaction analysis indicated the presence of CMV DNA in his cerebrospinal fluid (CSF), anti-viral therapy was added. Forty days after symptom onset, despite an initial positive response to this therapy, he developed dysarthria and truncal ataxia. Repeated magnetic resonance imaging scans demonstrated progressively expanding lesions involving not only the spinal cord but also the cerebral white matter, suggestive of extensive immune-mediated demyelination involving the central nervous system (CNS), as is observed in acute disseminated encephalomyelitis (ADEM). CONCLUSION: This case report underscores the importance of careful patient observation following the initial diagnosis of a CMV-associated CNS infection, such as transverse myelitis, on the possibility that post-infectious ADEM may appear. SN - 1471-2377 UR - https://www.unboundmedicine.com/medline/citation/27855658/Cytomegalovirus_associated_encephalomyelitis_in_an_immunocompetent_adult:_a_two_stage_attack_of_direct_viral_and_delayed_immune_mediated_invasions__case_report_ L2 - https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-016-0761-6 DB - PRIME DP - Unbound Medicine ER -