Epstein-Barr virus encephalitis in solid organ transplantation.
Epstein-Barr virus (EBV) is typically associated with post transplant lymphoproliferative disease (PTLD) after solid organ and stem cell transplantation. However, it is rarely associated with neurological complications. We report a case of severe encephalitis complicating primary EBV infection six months post renal transplantation, and review the literature on EBV encephalitis in solid organ transplantation in adults. A 55-year-old male presented 6 months post cadaveric renal transplant with headache, fever and confusion. Neuroimaging was unremarkable, but an electroencephalogram was consistent with diffuse encephalopathy. EBV DNA was detected in both cerebrospinal fluid (13,177 copies/ml), and plasma (14,166 copies/ml). Management included reduction of immunosuppression, intravenous ganciclovir and intravenous immunoglobulin, and resulted in a reduction in EBV viral load in both plasma and cerebrospinal fluid. The patient made a full recovery with no long-term neurological deficits and preservation of the graft. This case highlights the importance of knowing donor and recipient EBV serostatus at time of transplant, and closely monitoring EBV DNA when there is a mismatch. Ganciclovir or valganciclovir prophylaxis has also been shown to reduce the incidence of primary EBV infection in renal transplantation in these recipients. Treatment options for EBV infection post-transplant include reduction of immunosuppression, antiviral therapy, IVIg, and monoclonal antibody therapy directed toward infected B lymphocytes.
['Lau|Jillian S Y|JSY|', 'Low|Zhi Mei|ZM|', 'Abbott|Iain|I|', 'Shochet|Lani|L|', 'Kanellis|John|J|', 'Kitching|Arthur Richard|AR|', 'Korman|Tony M|TM|']
D000998:Antiviral Agents D004279:DNA, Viral D018792:Encephalitis, Viral D020031:Epstein-Barr Virus Infections D015774:Ganciclovir D004854:Herpesvirus 4, Human D006801:Humans D016756:Immunoglobulins, Intravenous D007155:Immunologic Factors D016030:Kidney Transplantation D008297:Male D008875:Middle Aged D011183:Postoperative Complications D019562:Viral Load
Epstein-Barr virus Encephalitis Transplant Immunosuppression