Longitudinally Extensive Transverse Myelitis (LETM) and Meningoencephalitis Following Acute Epstein-barr Virus Infection in an Immunocompetent Male: Case Report and Review Literature.

Abstract

Introduction: Epstein-Barr Virus (EBV) causes heterophile-positive Infectious Mononucleosis (IM), which manifests fever, sore throat, lymphadenopathy, and atypical lymphocytosis. In the Central Nervous System (CNS), EBV can cause acute encephalitis, cerebellar ataxia, Acute Disseminated Encephalomyelitis (ADEM), myelitis, meningitis, and radiculopathy. Reports of acute transverse myelitis linked to EBV infection are limited; therefore, Longitudinally Extensive Transverse Myelitis (LETM) due to EBV infection is extremely uncommon.

Case report: An 18-year-old male, otherwise healthy, was admitted to the medicine department with ten days of fever, headache, and vomiting and five days of altered sensorium. Subsequently, his neurological test showed bilateral upper motor neuron quadriparesis, sensory impairment, and bladder-bowel involvement. Spinal T2W MRI indicated extensive cervical, thoracic, and lumbar hyperintense lesions. Laboratory investigations supported the diagnosis, which revealed a positive IgM Antibody for EBV Viral Capsid Antigen (VCA) in serum and EBV DNA PCR in Cerebrospinal Fluid (CSF). The final diagnosis was EBVinduced acute meningoencephalitis with longitudinally extensive transverse myelitis and incidental aortic coarctation. Following methylprednisolone pulse therapy, the patient recovered significantly.

Conclusion: The present case report aims to share our experience by highlighting awareness of the rarity and treatment outcome of EBV-induced LETM.