Successful Treatment of Epstein-Barr Virus Reactivation-associated Transverse Myelitis Following Herpes Zoster with Intravenous Rituximab in a Cord Blood Transplant Recipient

The Epstein-Barr virus (EBV) is associated with many malignancies and autoimmune diseases, including multiple sclerosis. In addition, EBV rarely but occasionally causes central nervous system (CNS) complications. We herein report a case of transverse myelitis (TM) associated with systemic EBV reacti...

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Published inInternal Medicine Vol. 63; no. 17; pp. 2445 - 2450
Main Authors Sato, Keijiro, Watanabe, Rie, Ito, Ichiro, Imadome, Ken-Ich, Sumi, Masahiko, Kobayashi, Hikaru
Format Journal Article
LanguageEnglish
Published Japan The Japanese Society of Internal Medicine 01.09.2024
Japan Science and Technology Agency
Subjects
autoimmune
Autoimmune diseases
Blood cells
Case Report
Case reports
Central nervous system
Cord blood
Epstein-Barr virus
Herpes zoster
Intravenous administration
Lymphocytes B
Malignancy
Multiple sclerosis
Myelitis
Peripheral blood
Rituximab
transverse myelitis
Epstein-Barr virus
transverse myelitis
autoimmune
rituximab
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Summary:The Epstein-Barr virus (EBV) is associated with many malignancies and autoimmune diseases, including multiple sclerosis. In addition, EBV rarely but occasionally causes central nervous system (CNS) complications. We herein report a case of transverse myelitis (TM) associated with systemic EBV reactivation after herpes zoster infection in a cord blood transplant recipient. Identification of EBV-infected peripheral blood cells revealed a predominance of B cells. Notably, intravenous rituximab ameliorated EBV reactivation and TM. Since the CNS infiltration rate of intravenous rituximab is markedly low, the clinical efficacy of rituximab against TM suggests that EBV reactivation may cause TM via immune-mediated mechanisms.
Bibliography:ObjectType-Case Study-2
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Correspondence to Dr.　Keijiro Sato, k.ssto.shv@gmail.com
ISSN:0918-2918
1349-7235
1349-7235
DOI:10.2169/internalmedicine.2874-23