Acute Disseminated Encephalomyelitis Related to a Cytomegalovirus Infection in an Immunocompetent Patient.
Acute Disseminated Encephalomyelitis Related to a Cytomegalovirus Infection in an Immunocompetent Patient.
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DOI：
10.7759/cureus.12795
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发表时间：
2021-01-19
期刊：
影响因子：
--
通讯作者：
Matsuda J
中科院分区：
文献类型：
--
作者：
Da Silva RC;Aguiar GB;Kamer C;Farias L;Matsuda J
巨细胞病毒（CMV）感染可引起急性播散性脑脊髓炎（ADEM）。然而，它在免疫功能正常的人中很少见。我们描述了一个17岁的病人谁是流感样症状。一周后，她出现四肢快速进行性无力，随后昏迷。神经系统检查显示对语言和疼痛刺激无反应。双下肢出现巴宾斯基征，四肢沿着出现阵挛和反射亢进。脑磁共振成像（MRI）显示，在液体衰减反转恢复（FLAIR）序列上，白色物质中存在广泛的高信号区域，该区域在两个半球以及脑干和小脑脚中不对称分布，与急性脱髓鞘病变相符。脑脊液（CSF）显示轻度淋巴细胞增多和正常葡萄糖水平。单纯疱疹病毒聚合酶链反应阴性。血清免疫球蛋白G（IgG）和免疫球蛋白M（IgM）均为巨细胞病毒阳性。患者接受甲基强的松龙冲击治疗5天。随后，患者出现神经功能改善，意识和肌肉力量恢复。在预后方面，ADEM患者诊断越早，预后越好。治疗的基础是用类固醇进行免疫抑制。有些患者需要静脉注射免疫球蛋白G（IVIG）或血浆置换，在难治性病例中，使用环磷酰胺。
Cytomegalovirus (CMV) infection can cause acute disseminated encephalomyelitis (ADEM). However, it is rare in immunocompetent people. We describe a 17-year-old patient who was brought with flu-like symptoms. After one week, she experienced rapidly progressive weakness in all four extremities, followed by coma. The neurologic examination showed no response to verbal and pain stimuli. A Babinski sign was noted in both lower extremities, along with clonus and hyperreflexia in all four limbs. Brain magnetic resonance imaging (MRI) demonstrated extensive areas of hyperintense signal on fluid-attenuated inversion recovery (FLAIR) sequences in the white matter which was asymmetrically distributed in both hemispheres, as well as in the brainstem and cerebellar peduncles, compatible with acute demyelinating lesions. Cerebrospinal fluid (CSF) showed mild lymphocytic pleocytosis and normal glucose levels. Polymerase chain reaction to herpes simplex virus was negative. Serum immunoglobulin G (IgG) and immunoglobulin M (IgM) were positive for cytomegalovirus. The patient was treated with methylprednisolone pulse therapy for five days. Subsequently, the patient showed neurologic improvement with the recovery of consciousness and muscle strength. In terms of prognosis, in patients with ADEM, the sooner the diagnosis, the better the outcome. The cornerstone of treatment is immunosuppression with steroids. Some patients require intravenous immunoglobulin G (IVIG) or plasmapheresis, and in refractory cases, cyclophosphamide is used.
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