Acute Myelitis and Neuritis Assoclated with Multiple Herpesvirus Infections

Abstract

Abstract: We report a three-year-old boy who suffered from myelitis and neuritis which were considered to be associated with herpesvirus infection. Initial manifestations of this patient were lethargy, hoarseness, weakness and ataxia. He developed fever and exudative tonsilitis two weeks prior to this illness. Upon physical examination, decreased muscle power and deep tendon reflex of four extremities were disclosed. Romberg test was positive as well. There was no cerebellar sign. Examination of cerebrospinal fluid showed albuminocytologic dissociation (protein: 294mg/dl, cell count: 1). Nerve conduction velocity study revealed marked slowing of both motor and sensory nerves. Magnetic resonance image showed bright signal in T2 image of cervical cord (from C2 to C4), especially at the dorsal aspect. The positive IgM antibodies against these three viruses confirmed active infection with human herpesvirus type 6, cytomegalovirus, and Epstein-Ban virus (EBV). Furthermore, significant rise of IgG antibody against cytomegalovirus and EBV was demonstrated. The presence of antibody against EBNA in the first serum sample indicated a reactivated EBV infection. This report illustrated the association of herpesvirus infection and neuropathy and myelitis. Whether the more severe clinical manifestation was due to multiple herpesvirus infections awaits further study.