The spectrum of Epstein-Barr virus infections of the central nervous system after organ transplantation

• Published in: Virology journal Vol. 18; no. 1; p. 162
• Main Authors: Ridha, Mohamed, Jones, Dylan G, Lerner, David P, Vytopil, Michal, Voetsch, Barbara, Burns, Joseph D, Ramineni, Anil, Raibagkar, Pooja
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06.08.2021; BioMed Central; BMC
• Subjects: Aged; Antigens; Case Report; Central nervous system; Central nervous system diseases; Central Nervous System Infections - virology; Cirrhosis; Complications and side effects; Cytotoxicity; Disease; Electronic medical records; Encephalitis; Epstein-Barr virus; Epstein-Barr virus diseases; Epstein-Barr Virus Infections - complications; Epstein-Barr Virus Infections - diagnosis; Female; Gait; Herpesvirus 4, Human; Humans; Infections; Literature reviews; Liver cirrhosis; Liver transplantation; Liver Transplantation - adverse effects; Liver transplants; Living Donors; Lymphocytes; Lymphoma; Magnetic resonance imaging; Male; Middle Aged; Myelitis; Nervous system; Neurologic manifestations of general diseases; Neurological complications; Patients; Post-transplant lymphoproliferative disorder; Primary biliary cirrhosis; Retrospective Studies; Risk factors; Serology; Spinal cord; Transplantation of organs, tissues, etc; United States; Post-transplant lymphoproliferative disorder; Epstein-Barr virus; Central nervous system
• ISSN: 1743-422X; 1743-422X
• DOI: 10.1186/s12985-021-01629-6

Epstein-Barr virus (EBV)-related neurologic complications have a diverse presentation in transplant recipients, creating diagnostic and therapeutic challenges for clinicians. In this case series, we report unique manifestations of EBV related neurologic complications following solid organ transplant and highlight pitfalls in management. A retrospective search of the electronic medical record of all patients from January 2015 to December 2020 who underwent solid organ transplantation and had central nervous system complications as determined by ICD-10 codes were included. Three patients with unique manifestation of EBV-related neurologic complications after liver transplantation were identified. The first was a 52-year-old man with a live-donor liver transplant 11 years prior for Budd-Chiari syndrome presented with several weeks of headache and several lesions on brain MRI; he was diagnosed with primary central nervous system post-transplant lymphoproliferative disorder. The second patient was a 63-year-old man with a deceased-donor liver transplant 16 years prior for alpha-1-antitrypsin deficiency and was found to have a stroke; he was diagnosed with EBV encephalitis. The final patient was a 75-year-old woman with a deceased-donor liver transplant six years prior for primary biliary cirrhosis who presented with four months of gait instability; she was diagnosed with EBV myelitis. A review of the literature was performed to supplement description of the different diseases. EBV-related central nervous infection in post-transplant patients can manifest in a variety of neurologic syndromes, which can be challenging to diagnose. Careful correlation of clinical, pathologic, and radiologic findings and a high index of suspicion are crucial in identification and appropriate management.