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 lym-phocytosis. In the Central Nervous System (CNS), EBV can cause acute encephalitis, cere-bellar ataxia, Acute Disseminated Encephalomyelitis (ADEM), myelitis, meningitis, and radiculopathy. Reports of acute transverse myelitis linked to Epstein-Barr Virus (EBV) in-fection 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 depart-ment with ten days of fever, headache, and vomiting and five days of altered sensorium. Subsequently, his neurological test showed bilateral upper motor neuron quadriparesis, sen-sory impairment, and bladder-bowel involvement. Spinal T2W MRI indicated extensive cer-vical, thoracic, and lumbar hyperintense lesions. Laboratory investigations supported the di-agnosis, 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 EBV-induced acute meningoencephalitis with longitudinally extensive transverse myelitis and in-cidental aortic coarctation. Following methylprednisolone pulse therapy, the patient recov-ered significantly.

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