Mononeuritis multiplex associated with primary EBV infection

Abstract

• Neurologic complications can follow primary EBV infection, although these are rare. • EBV should be considered as a precipitant of unexplained mononeuritis multiplex. • EBV serology requires repeating and careful interpretation to demonstrate evolution of antibody responses and to confirm the diagnosis. A 20 year old lady presented to the acute medical unit with new neurological deficits. She described gastrointestinal symptoms in the preceding 24 hours. Her case was discussed with infectious diseases and neurology overnight, both of whom were resident at a hospital on the other side of the city. The infectious diseases team were concerned enough to discuss the case with Public Health England for consideration of botulism antitoxin. When this diagnosis was discounted on the basis of asymmetric neurological deficits, the patient was admitted under the care of the neurologists. Mononeuritis multiplex of unclear aetiology was diagnosed. A subsequent infectious diseases review resulted in a diagnosis of primary EBV infection, the likely trigger of the symptoms. Whilst neurologic deficits resolved, neuropathic pain continues. Learning points include the importance of an early, accurate description of neurologic deficits and the need to consider EBV as an infectious trigger of mononeuritis multiplex. Collaboration between neurology and infectious disease physicians was key in managing this patient and disentangling the broad array of infectious and non-infectious differential diagnoses.