Severe Epstein-Barr virus encephalitis with peripheral nerve damage: A case report.

Rationale: Epstein-Barr virus (EBV) is a B-lymphotropic double-stranded DNA virus. Most people infected with EBV are asymptomatic infection. Its clinical symptoms are rarely manifested as EBV encephalitis, and peripheral nerve damage is even rarer.

Patient Concerns: We report a case of a 49-year-old woman with a history of fever. The initial symptoms were numbness and weakness in the right hand, followed by slurred speech. Electromyography showed severe damage to the median nerve of the right wrist (involving sensory and motor fibers). Magnetic resonance imaging revealed multiple lesions in the bilateral cerebral hemispheres on T2 FLAIR images, and T1-enhanced images showed abnormal enhancement of the adjacent leptomeninges. Human herpesvirus 4 (EBV) has been detected in the cerebrospinal fluid using metagenomic next-generation sequencing (NGS). After antiviral treatment, the patient's symptoms continued to worsen.

Diagnosis: Severe EBV encephalitis complicated with peripheral nerve damage.

Interventions: Antiviral, hormone therapy.

Outcomes: At the patient's condition progressed, a new infarction occurred in the right frontal lobe lesion, with repeated high fever, rapid deterioration of multiple organ function, sudden respiratory failure, cardiac arrest, and death.

Lessons: In patients with signs of encephalitis, cerebrospinal fluid NGS should be used as early as possible to confirm the diagnosis of EBV encephalitis. Timely and accurate treatment of central nervous system infections is expected to reduce the mortality rate and improve the quality of life of patients in later stages.