Abstract
In pediatric patients Epstein-Barr virus (EBV) infection may have miscellaneous neurological manifestations. Children with acute viral encephalopathy may present prolonged electrographic seizure activity consistent with non-convulsive status epilepticus (NCSE). NCSE condition is difficult to diagnose due to absence of motor seizures, presenting only changes in behavior and consciousness. In this report we present a clinical case of EBV infection in 3.5-year-old girl. On admission she suffered of confusional state and irritability after an episode of motor partial complex seizure being in good health. The condition evolved twenty five days after an episode of respiratory infection diagnosed as bacterial tonsillitis by the family physician and treated with antibacterials. Laboratory blood evaluation as well as chest radiography, urinalysis, bleeding time, fibrinogen were within the normal range. Magnetic resonance imaging of the brain and spinal cord revealed a subcortical increased signal in the left occipital lobe on T2-weighted image. Electroencephalography (EEG) pattern revealed non-convulsive status epilepticus (NCSE). EBV infection was revealed by serum antibody test. The present case emphasizes the importance to evaluate the role of EBV in acute neurological syndromes in pediatric patients, in particular, in presence of behavioral changes with EEG evidence of seizures. NCSE in children denotes electrographic seizures without convulsive activity and often manifests as altered mental status. It may be difficult to diagnose in pediatric patients in whom changes of behavior and consciousness may not be as easily recognized as in adults.
Highlights
In pediatric patients Epstein-Barr virus (EBV) infection may have miscellaneous neurological manifestations, including encephalitis, meningitis, acute disseminated encephalomyelitis, as well as acute inflammatory polyneuropathy
In this report we present a clinical case of EBV infection in 3.5-year-old girl
EBV infection was revealed by serum antibody test
Summary
In pediatric patients Epstein-Barr virus (EBV) infection may have miscellaneous neurological manifestations, including encephalitis, meningitis, acute disseminated encephalomyelitis, as well as acute inflammatory polyneuropathy. EBV infection was revealed by serum antibody test. At the age of 3 years and 4 months, the patient developed fever (39.5 C0) and sore throat which lasted for 3 days. After 25 days from the end of the antibacterial treatment the patient exhibited a motor partial complex seizure being in good health. The seizure was followed by an acute confusional state that lasted for 2 hours. On admission her weight was 13.5 kg (10th percentile), height 95 cm (10th percentile), and head circumference 49 cm (50th percentile). Improvement of EEG patterns, was observed after three days (organization of background activity). She presented a full clinical recovery and neurological examination was normal. EEG showed normal activity with a good alpha organization in the occipital area
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