Table 2.
Summary of testing and outcomes of cases
| Diagnosis | Case 1: post-transplant lymphoproliferative disorder (PTLD) | Case 2: EBV encephalitis | Case 3: EBV myelitis |
|---|---|---|---|
| EBV serology |
EBNA IgG − EBV VCA IgM − EBV VCA IgG + EBV EA IgG + |
Not performed |
EBNA IgG + EBV VCA IgM ± b EBV VCA IgG + EBV EA IgG + |
| EBV CSF PCR | Positive | Positive (quantitative EBV PCR: 383,000 copies/mL) | Positive |
| CSF profilea |
WBC 12; lymphocytes 81% (occasional plasmacytoid and atypical cells) < 1 RBC Protein 36 Glucose 53 |
WBC 171; lymphocytes 95% RBC 234 Protein 169 Glucose 63 |
WBC 23; lymphocytes 95% < 1 RBC Protein 60 Glucose 55 |
| Other serum testing |
CBC, CMP California virus, East Equine encephalitis, St. Louis encephalitis, West Equine encephalitis Treponemal antibody ANA HIV QuantiFERON Anaplasma, Ehrlichia Lyme Aspergillus galactomannan Anti-aquaporin-4 IgG Anti-MOG IgG C-reactive protein Vitamin B12 |
CBC, CMP Treponemal antibody HIV QuantiFERON Lyme |
CBC, CMP Vitamin B12 Methylmalonic acid Copper Vitamin E Zinc HIV Lyme Treponemal antibody ANA ACE ANCA Anti-aquaporin-4 IgG Anti-MOG IgG |
| Other CSF testing |
Herpes simplex virus I/II PCR Listeria Cryptococcal antigen Varicella zoster PCR Toxoplasma PCR Tropherma whipple Mycoplasma Histoplasma Cytomegalovirus PCR Enterovirus PCR JC virus PCR HHV-6 PCR Oligoclonal bands Cytology Flow cytometry |
Herpes simplex virus I/II PCR Cryptococcal antigen Varicella zoster PCR Cytomegalovirus PCR Cytology Flow cytometry Universal bacterial and fungal PCR |
Herpes simplex virus I/II PCR Cryptococcal antigen Varicella zoster PCR Cytomegalovirus PCR paraneoplastic panel VDRL oligoclonal bands West-Nile virus PCR HHV-6 PCR |
| Treatment |
1. rituximab, prednisone, methotrexate 2. IV ganciclovir then po valganciclovir; tacrolimus held |
Mycophenolate mofetil held, tacrolimus continued; IV acyclovir then transitioned to IV ganciclovir | Mycophenolate held, tacrolimus continued; IV solumedrol |
| Outcome | Significant improvement 20 weeks after presentation with residual radiographic lesions | Deceased | Complete recovery 5 months later |
ACE, angiotensin converting enzyme; ANCA, antineutrophil cytoplasmic antibodies; ANA, antinuclear antibody; CBC, complete blood cell count; CMP, complete metabolic panel; CSF, cerebral spinal fluid; EA, early antigen; EBER, Epstein-Barr encoding region; EBNA, Epstein-Barr nuclear antigen; EBV, Epstein-Barr virus; HHV-6, Human Herpesvirus 6; HIV, human immunodeficiency virus; IV, intravenous; JC virus, John Cunningham virus; LMP1, latent membrane protein 1; MOG, myelin oligodendrocyte glycoprotein; RBC, red blood cell count; VCA, viral capsid antigen; VDRL, venereal disease research laboratory; WBC, white blood cell count
aLab reference values: WBC < 10 cells/μL, RBC < 1 cells/μL, lymphocytes 40–80%, protein 15–45 mg/dL, glucose 40–70 mg/dL)
b+/−Means borderline/equivocal