SHM Converge Scientific Abstract ePoster Gallery-The Diagnostic Challenge of Ebv Encephalitis in Adults

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This case report highlights the diagnostic challenge of Epstein-Barr virus (EBV) encephalitis in adults. EBV is classically linked to infectious mononucleosis, but it can also cause a range of neurologic complications, including Bell’s palsy, cerebellar ataxia, Guillain-Barré syndrome, seizures, and encephalitis. Adult cases are uncommon and often difficult to recognize because symptoms may occur without typical mononucleosis features.<br /><br />The report describes a woman in her 70s with hypothyroidism who presented with left-hand paresthesia, numbness, and dizziness. During hospitalization, she developed worsening encephalopathy and rapidly progressive quadriparesis. She was initially treated with IVIG for suspected Guillain-Barré syndrome, but cerebrospinal fluid findings did not support that diagnosis. She was then started on empiric acyclovir, ceftriaxone, and doxycycline. Most of her workup was negative, but EBV PCR returned positive. MRI showed patchy hyperintensities in the right parietal lobe, left cerebellum, basal ganglia, and no meningeal or parenchymal enhancement.<br /><br />The discussion notes that EBV may account for about 5% of viral encephalitis cases. Proposed mechanisms include direct viral invasion and immune-mediated injury. MRI findings can be abnormal but are variable and nonspecific. Diagnosis is usually made through EBV antibodies and PCR testing in blood or cerebrospinal fluid. There are no established treatment guidelines; supportive care remains standard, though early acyclovir and steroids may be considered in critically ill patients.<br /><br />The patient improved significantly with steroids and was discharged on a prednisone taper. The authors emphasize that EBV should be considered in adults presenting with acute encephalopathy, even when classic viral symptoms are absent.

Asset Subtitle

Rashelle Ripa

Meta Tag

Author List Farah Yassine, Mahija Cheekati, Megha Churivella, Rashelle Ripa

Category Clinical Vignettes

Concept HSV-1 Encephalitis

Concept Acute Encephalopathy

Concept Neurological Manifestation

Concept Polymerase Chain Reaction

Concept Cerebrospinal Fluid

Distinguished Non-Finalist

Presenter Organization Morristown Medical Center

Presenting Author Rashelle Ripa

Track Adult

Keywords

Epstein-Barr virus

EBV encephalitis

adult encephalitis

diagnostic challenge

acute encephalopathy

quadriparesis

cerebrospinal fluid PCR

MRI hyperintensities

steroid treatment

viral encephalitis

HSV-1 Encephalitis

Acute Encephalopathy

Neurological Manifestation

Polymerase Chain Reaction

Cerebrospinal Fluid