A cause of acute encephalitis: prime-infection due to Epstein-Barr virus

The neurologic complications of Epstein-Barr virus (EBV) primary infection are frequently overlooked, yet EBV is responsible for some cases of acute e ncephalitis. We report on a case of an infant with acute brain-stem encepha litis during EBV primary infection. Observation. - A 22-month-old boy was admitted to the hospital for acute ne urological symptoms. Initially, he presented ataxia and dysphagia. During t he first days, his neurological status worsened with loss of consciousness requiring ventilatory support. A progressive improvement appeared after a I week course. One month later, a moderate ataxia was still noted, but 3 mon ths later, the clinical examination was normal. The neuroradiological explo rations revealed damage of the white matter with high T2-weighed signal on the first brain magnetic resonance imaging. One month later the control mag netic resonance imaging was normal. The diagnosis of EBV encephalitis was b ased upon the exclusion of other possible causes and positive serology for EBV; consistent with acute primary infection. Conclusion. - EBV infection should be looked for during the etiologic work- up of an acute encephalitis. The different cases reported in the literature show a favorable initial outcome, but neurological relapse and sequelae ar e possible. No specific treatment is effective. (C) 1999 Elsevier, Paris.