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Abstract Details

Antiviral Therapy in the Management of Epstein-Barr Virus Encephalitis
Infectious Disease
P2 - Poster Session 2 (2:45 PM-3:45 PM)
074
To discuss antiviral therapy in the management of Epstein-Barr Virus (EBV) encephalitis.
EBV encephalitis is a rare form of viral encephalitis in adults, often associated with immunocompromised states. While typical treatment consists of supportive care, corticosteroids or IVIG, use of antiviral therapies is controversial and limited in data. We present a patient with recurrent hospitalizations with various neurological symptoms and chronic neurocognitive impairment who was diagnosed with EBV encephalitis and treated with antiviral therapy, supportive care, and immune reconstituting therapy.
Clinical Case

A 35-year-old female with HIV (CD4 count < 200) presented with seizures, fever, and encephalopathy, concerning for meningoencephalitis. MRI brain showed white matter FLAIR hyperintensities and CSF showed a protein of 72mg/dL, WBC count of 11mcL, and glucose of 55mg/dL. She improved with supportive care and antiepileptic medications, was started on Biktarvy and discharged. 

She returned seven months later with lower extremity weakness and gait difficulties. CSF showed a protein of 118mg/dL, WBC count 20mcL, glucose of 39mg/dL, with a positive qualitative EBV PCR. MRI results showed progressed white matter disease. 

She returned two months later with somnolence, headache, and blurred vision. MRI showed worsened white matter disease. CSF showed a WBC count of 58mcL, protein of 113mg/dL, glucose of 35mg/dL and quantitative EBV PCR was positive at 1384 copies/ml.

CSF cytology, JCV and CMV PCR studies were sent multiple times and were negative. 

Due to concern for EBV encephalitis, she was started on a five day course of IV ganciclovir followed by oral valganciclovir.

At follow-up, she had notable improvements in cognitive function.
While treatment of EBV encephalitis often involves supportive care or symptomatic treatments, there are growing reports on use of antiviral therapies. This case adds support to the currently limited data on use of antiviral therapy for EBV-associated encephalopathy.
Authors/Disclosures
Madison Crawford
PRESENTER 		Madison Crawford has nothing to disclose.
Andres Alvarez Mr. Alvarez has nothing to disclose.
Anna Babaie, DO Dr. Babaie has nothing to disclose.
Karuna Kusan Karuna Kusan has nothing to disclose.