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Case Report
 
Limbic encephalitis caused by Epstein–Barr virus: A case report
Zia-ul-haq Peerzada1, Peer Sameer1, Dar Mohammad Salim1, Wani Abdul Haseeb1, Shiekh Yassar1, Shafi Fahad1
1MBBS, Radiology resident, Department of Radiodiagnosis and Imaging, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India.

Article ID: Z01201606CR10656ZP
doi:10.5348/ijcri-201668-CR-10656

Address correspondence to:
Dr Sameer Peer
Department of Radiodiagnosis & Imaging
Sher-i-Kashmir Institute of Medical Sciences, Soura
Srinagar, Jammu & Kashmir
India, 190011

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How to cite this article
Zia-ul-haq P, Sameer P, Salim DM, Haseeb WA, Yassar S, Fahad S. Limbic encephalitis caused by Epstein–Barr virus: A case report. Int J Case Rep Images 2016;7(6):378–383.


Abstract
Introduction: Epstein–Barr virus (EBV) is a double-stranded DNA virus which belongs to the family of herpes viruses. It is a lymphotropic virus affecting the B-lymphocytes and epithelial cells. Neurological manifestations of EBV infection are rare and may or may not co-inside with infectious mononucleosis. A wide range of neurological manifestations of EBV infection have been reported and include, encephalitis, meningitis, cerebellitis, acute disseminated encephalomyelitis (ADEM), transverse myelitis and radiculopathy. Limbic encephalitis caused by EBV is a very rare condition which has been reported in recipients of allogeneic hematopoietic stem cell transplant.
Case Report: We report a case of limbic encephalitis caused by EBV in an immunocompetent 75-year-old woman with no history of infectious mononucleosis and no history of allogeneic hematopoietic stem cell transplantation. Diagnosis of limbic encephalitis was suspected on MR imaging. EBV as a causative agent was confirmed on polymerase chain reaction (PCR) of cerebrospinal fluid sample which demonstrated rising titres of EBV DNA. To the best of our knowledge, this is the first case report of limbic encephalitis caused by EBV in an immunocompetent elderly female with no history of allogeneic stem cell transplantation.
Conclusion: Limbic encephalitis is a very rare complication of EBV infection but it should be kept in the list of differential diagnosis while evaluating any patient presenting with clinical features of limbic encephalitis with MRI showing signal abnormalities in the limbic cortex. Establishing an early and accurate diagnosis is the key in management as complete recovery is possible on treatment.

Keywords: Epstein–Barr virus, Limbic encephalitis, Magnetic resonance imaging, Polymerase chain reaction


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Author Contributions
Zia-ul-haq Peerzada – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Peer Sameer – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Dar Mohammad Salim – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Wani Abdul Haseeb – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Shiekh Yassar – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Shafi Fahad – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Zia-ul-haq Peerzada et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



About The Authors

Peerzada Zia-ul-haq is a Resident at the Department of Radiodiagnosis & Imaging, Sher-i-Kashmir Institute of medical sciences, Srinagar, Jammu & Kashmir, India. He earned the MBBS degree from Aligarh Musilm University, UP, India. His research interests include emergency radiology and interventional radiology in trauma. He intends to pursue Interventional radiology in future.



Sameer Peer is a Resident at the Department of Radiodiagnosis & Imaging, Sher-i-Kashmir Institute of medical sciences, Srinagar, Jammu & Kashmir, India. He earned the MBBS degree from Government Medical College, Srinagar, Jammu & Kashmir, India. His research interests include contrast agents and contrast induced nephropathy, Radiation Protection, cardiovascular radiology and neuroradiology. He intends to pursue Vascular interventional radiology in future.



Mohammad Salim Dar is Resident at the Department of Radiodiagnosis & Imaging, Sher-i-Kashmir Institute of medical sciences, Srinagar, Jammu & Kashmir, India. He earned the MBBS degree from Government Medical college, Srinagar, Jammu & Kashmir, India. His research interests include gastrointestinal radiology and imaging of pancreas. He intends to pursue Gastrointestinal Radiology in future.



Abdul Haseeb Wani is a Radiology Resident at the Department of Radiodiagnosis & Imaging, Sher-i-Kashmir Institute of medical sciences, Srinagar, Jammu & Kashmir, India. He earned the MBBS degree from Government Medical college, Srinagar, Jammu & Kashmir, India. His research interests include imaging of gastric malignancies and imaging in epilepsy. He intends to pursue Neuroradiology in future.



Yassar Shiekh is a Resident at the Department of Radiodiagnosis & Imaging, Sher-i-Kashmir Institute of medical sciences, Srinagar, Jammu & Kashmir, India. He earned the MBBS degree from Government Medical college, Jammu, Jammu & Kashmir, India. His research interests include complications following lung biopsies and imaging of pediatric diseases. He intends to pursue Interventional radiology in future.



Fahad Shafi is a Resident at the Department of Radiodiagnosis & Imaging, Sher-i-Kashmir Institute of medical sciences, Srinagar, Jammu & Kashmir, India. He earned the MBBS degree from Government Medical College, Srinagar, Jammu & Kashmir, India. His research interests include percutaneous nephrostomy using micropuncture set and musculoskeletal radiology. He intends to pursue Musculoskeletal radiology in future.