Epstein-Barr virus meningoencephalitis in a immunocompetent child

Meningoencephalitis caused by the Epstein-Barr virus (EBV) is a rare neurological entity, most often related to the latent reactivation of thevirus associated with immunosuppression. The clinic varies between encephalitis, meningitis, cerebellitis, neuritis and transverse myelitis. The prognosis is good, with 85% of patients returning to baseline levels. Case report: We attend to a 11-month-old male patient, proper neuropsychomotor development, with reports of fever and odynophagia, without improvement with antibiotic therapy. He had a focal epileptic seizure. Upon admission, he presented a new similar event, with control after use of diazepam and intravenous phenobarbital. At the neurological examination carried out after improving the level of consciousness, the patient was alert. He presented axial hypotonia, dystonic posture in flexion of the right upper limb, with preserved strength. He showed no meningeal signs. The cerebrospinal fluid revealed 61 mg/dL of glucose, 57 mg/dL of proteins and 65/mm³ of leukocytes (90% of lymphocytes). Acyclovir, ceftriaxone, and dexamethasone were started, with improvement. Magnetic resonance imaging revealed: FLAIR hyper signal injury, with diffusion restriction, in the left caudate nucleus, left lentiform and ipsilateral anterior midbrain region. Electroencephalogram with diffuse attenuation of baseline electrical activity. The main diagnostic hypothesis was meningoencephalitis secondary to EBV infection, with confirmatory PCR-DNA. Conclusion: The report illustrates the need for attention to a rare infectious etiology in atypical presentation of meningoencephalitis.