Encephalopathy Associated with Severe Cytomegalovirus Infection in an Immunocompetent Young Woman.
Encephalopathy Associated with Severe Cytomegalovirus Infection in an Immunocompetent Young Woman.
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DOI：
10.1155/2021/5589739
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发表时间：
2021
影响因子：
1.1
通讯作者：
Kato H
中科院分区：
文献类型：
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作者：
Tetsuka S;Suzuki T;Ogawa T;Hashimoto R;Kato H
健康年轻人的原发性巨细胞病毒 (CMV) 感染通常是无症状或单核细胞增多症样综合征，而在免疫功能低下的患者中，CMV 可引起严重疾病。在这项研究中，我们报告了一个不寻常的原发性 CMV 感染病例，其中患者是一位免疫功能正常的 21 岁女性，出现严重脑病、急性肝炎、视网膜炎和潜伏 Epstein-Barr 病毒重新激活。她出现精神错乱、高烧、头痛和强直阵挛性癫痫发作。脑磁共振成像显示内侧颞叶和基底神经节有高强度病变。观察到肝功能障碍，腹部计算机断层扫描显示脾肝肿大。经过眼底检查，患者被诊断为巨细胞病毒性视网膜炎。入院后，她接受了静脉注射阿昔洛韦和类固醇冲击疗法。考虑到她严重的临床状况和血清白细胞介素6水平升高，我们推测她的病情类似于细胞因子风暴诱发的脑病。入院第2天，她的这些临床表现迅速恢复。由于发现血液 CMV pp65 抗原血症呈阳性，我们给予更昔洛韦 2 周。根据她的临床表现以及血液CMV DNA和CMV pp65抗原血症以及IgM动力学的存在，我们最终诊断该患者为严重的原发性CMV感染。入院20天后出院，无后遗症。免疫功能健全的年轻人中严重巨细胞病毒疾病的发病率可能比以前认识的要高。 CMV 无创检测（例如 CMV pp65 抗原血症和 CMV DNA 血症）已广泛应用，有助于早期诊断。短期糖皮质激素治疗可能有益于治疗原发性巨细胞病毒感染早期的脑病。考虑到这样的背景，临床医生应牢记严重的原发性巨细胞病毒感染，作为临床环境中的鉴别诊断。
Primary cytomegalovirus (CMV) infection in healthy young adults is usually an asymptomatic or mononucleosis-like syndrome, whereas in immunocompromised patients, CMV can cause significant disease. In this study, we report an unusual case of primary CMV infection wherein the patient, an immunocompetent 21-year-old woman, presented severe encephalopathy, acute hepatitis, retinitis, and reactivation of latent Epstein–Barr virus. She developed confusion, high fever, headache, and tonic-clonic seizures. Brain magnetic resonance imaging showed high-intensity lesions in the medial temporal lobe and basal ganglia. Liver dysfunction was observed, and abdominal computed tomography revealed splenohepatomegaly. After fundus findings, the patient was diagnosed with CMV retinitis. Upon admission, she was treated with intravenous acyclovir and steroid pulse therapy. Considering both her serious clinical condition and elevated serum levels of interleukin-6, we speculated that her condition was similar to cytokine-storm-induced encephalopathy. On day 2 after admission, she showed prompt recovery from these clinical manifestations. Since blood CMV pp65 antigenemia was found to be positive, we administered ganciclovir for 2 weeks. On the basis of her clinical manifestations and the presence of blood CMV DNA and CMV pp65 antigenemia along with IgM kinetics, we finally diagnosed this patient with severe primary CMV infection. She left our hospital without sequelae 20 days after admission. The incidence of severe CMV disease in immunocompetent young adults might be higher than previously recognized. Noninvasive testing for CMV (such as CMV pp65 antigenemia and CMV DNAemia) is widely available and can help early diagnosis. Short-term glucocorticoid therapy might be beneficial in the treatment of encephalopathy in the early stages of primary CMV infection. Considering such a background, clinicians should keep severe primary CMV infection in mind as a differential diagnosis in the clinical setting.
DOI：
10.7759/cureus.12795
发表时间：
2021-01-19
期刊：
Cureus
影响因子：
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作者：
Da Silva RC;Aguiar GB;Kamer C;Farias L;Matsuda J
通讯作者：
Matsuda J
影响因子：
1.1
作者：
Borges G;Neves D;Maury IP;Pereira A;Silva MJ
通讯作者：
Silva MJ