Open Access Highly Accessed Case report

Unusual MRI findings in an immunocompetent patient with EBV encephalitis: a case report

Paola Di Carlo1*, Marcello Trizzino1, Lucina Titone1, Giuseppina Capra1, Piero Colletti2, Giovanni Mazzola2, Daniela Pistoia1 and Caterina Sarno3

Author Affiliations

1 Dipartimento di Scienze per la Promozione della Salute, Università di Palermo, Italy

2 Dipartimento di Medicina Clinica e delle Patologie Emergenti, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo, Palermo, Italy

3 Dipartimento di Scienze Radiologiche, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo, Palermo, Italy

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BMC Medical Imaging 2011, 11:6  doi:10.1186/1471-2342-11-6

Published: 24 March 2011

Abstract

Blackground

It is well-known that Epstein-Barr virus (EBV) can affect the central nervous system (CNS).

Case presentation

Herein the authors report unusual timely Magnetic Resonance Imaging (MRI) brain scan findings in an immunocompetent patient with EBV encephalitis.

Diffusion weighted MRI sequence performed during the acute phase of the disease was normal, whereas the Fast Relaxation Fast Spin Echo T2 image showed diffuse signal intensity changes in white matter. The enhancement pattern suggested an inflammatory response restricted to the brain microcirculation. Acyclovir and corticosteroid therapy was administered. After three weeks, all signal intensities returned to normal and the patient showed clinical recovery.

Conclusion

This report demonstrates that EBV in an immunocompetent adult can present with diffuse, reversible brain white matter involvement in the acute phase of mononucleosis. Moreover, our case suggests that a negative DWI sequence is associated with a favorable improvement in severe EBV CNS infection. More extensive studies are needed to assess what other instrumental data can help to distinguish viral lesions from other causes in the acute phase of disease.

Keywords:
Epstein-Barr virus; encephalitis; MRI; Diffusion-weighted imaging