ENCEPHALOMYELORADICULOPATHY ASSOCIATED WITH EPSTEIN-BARR-VIRUS - PRIMARY INFECTION OR REACTIVATION

Introduction - Encephalomyeloradiculopathy (EMR) is a new syndrome, ch aracterized by extensive involvement of the nervous system at differen t levels, including brain, medulla and spinal roots. We describe a pat ient presenting with prodromal febrile illness, followed by a wide inf ection of the nervous system with transverse myelitis anti less severe meningitis, encephalitis and polyradiculopathy. The patient was treat ed with high-dose corticosteroids, antibiotics and acyclovir; in spite of therapy his condition improved very slowly, with severe neurologic al sequelae. Material and methods - Antiviral antibodies were searched for in serum and cerebrospinal fluid (CSF) by commercially available ELISA kits. Viral investigations were performed by eel culture isolati on and search for viral antigens, and genomic nucleic acids were inves tigated by polymerase chain reaction (PCR). Results - Virological and serological studies evidenced a primary infection by cytomegalovirus ( CMV), possibly responsible for the prodromal illness, persisting in th e course of the disease. PCR performed in the peripheral blood mononuc lear cells (PBMCs), DNA collected early and in the CSF drawn 30 days a fter the onset of the disease showed Epstein-Barr virus (EBV) DNA. The serum panel of EBV antibodies was typical of an intercurrent virus re activation, more than of a primary infection. Conclusion - EBV is know n to be highly infectious for the nervous system, in this case of EMR the presence of DNA sequences in the PBMCs and CSF suggests that EBV p lays a role in the development of this newly described syndrome.