Autopsy and Case Reports
https://www.autopsyandcasereports.org/article/doi/10.4322/acr.2016.033
Autopsy and Case Reports
Article / Clinical Case Report

Simultaneous genital ulcer and meningitis: a case of EBV infection

Hassan Rahhal, Jairo Tavares Nunes, Leonardo da Costa Lopes, Aleksander Snioka Prokopowitsch

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Abstract

The Epstein-Barr virus (EBV) is associated with a broad spectrum of diseases, mainly because of its genomic characteristics, which result in different latency patterns in immune cells and infective mechanisms. The patient described in this report is a previously healthy young man who presented to the emergency department with clinical features consistent with meningitis and genital ulcers, which raised concern that the herpes simplex virus was the causative agent. However, the polymerase chain reaction of cerebral spinal fluid was positive for EBV. The authors highlight the importance of this infection among the differential diagnosis of central nervous system involvement and genital ulceration.

Keywords

Meningitis, Viral, Epstein-Barr Virus Infections, Ulcer, Genital Diseases.

References

1. Nesher L, Hadi CM, Salazar L, et al. Epidemiology of meningitis with a negative CSF Gram stain: underutilization of available diagnostic tests. Epidemiol Infect. 2016;1(01):189-97. http://dx.doi.org/10.1017/S0950268815000850. PMid:25989841.

2. Oteo JA. Meningitis aséptica aguda: muchas causas a considerar. Oteo, JA. Enferm Infecc Microbiol Clin. 2012;30(7):359-60. http://dx.doi.org/10.1016/j.eimc.2012.05.004. PMid:22763113.

3. Lee BE, Davies HD. Aseptic meningitis. Curr Opin Infect Dis. 2007;20(3):272-7. http://dx.doi.org/10.1097/QCO.0b013e3280ad4672. PMid:17471037.

4. Irani DN. Aseptic meningitis and viral myelitis. Neurol Clin. 2008;26(3):635-55, vii-viii. http://dx.doi.org/10.1016/j.ncl.2008.03.003. PMid:18657719.

5. Seehuse DA, Reeves MM, Formin DA. Cerebrospinal fluid analysis. Am Fam Physician. 2003;68(6):1103-8. PMid:14524396.

6. Bastos MS, Lessa N, Naveca FG, et al. Detection of Herpesvirus, Enterovirus, and Arbovirus infection in patients with suspected central nervous system viral infection in the Western Brazilian Amazon. J Med Virol. 2014;86(9):1522-7. http://dx.doi.org/10.1002/jmv.23953. PMid:24760682.

7. Dupuis M, Hull R, Wang H, et al. Molecular detection of viral causes of encephalitis and meningitis in New York State. J Med Virol. 2011;83(12):2172-81. http://dx.doi.org/10.1002/jmv.22169. PMid:22012726.

8. Ory F, Avellón A, Echevarría JE, et al. Viral infections of the central nervous system in Spain: a prospective study. J Med Virol. 2013;85(3):554-62. http://dx.doi.org/10.1002/jmv.23470. PMid:23239485.

9. Hall LD, Eminger LA, Hesterman KS, Heymann WR. Epstein-Barr virus: dermatologic associations and implications: part I. Mucocutaneous manifestations of Epstein-Barr virus and nonmalignant disorders. J Am Acad Dermatol. 2015;72(1):1-19, quiz 19-20. http://dx.doi.org/10.1016/j.jaad.2014.07.034. PMid:25497917.

10. Fujimoto H, Asaoka K, Imaizumi T, Ayabe M, Shoji H, Kaji M. Epstein-Barr virus infections of the central nervous system. Intern Med. 2003;42(1):33-40. http://dx.doi.org/10.2169/internalmedicine.42.33. PMid:12583615.

11. Patil AK, Azad ZR, Mathew V, Alexander M. Chronic meningitis and central nervous system vasculopathy related to Epstein Barr vírus. Ann Indian Acad Neurol. 2012;15(4):303-6. http://dx.doi.org/10.4103/0972-2327.104342. PMid:23349599.

12. Brinca A, Canelas MM, Carvalho MJ, Vieira R, Figueiredo A. Lipschütz ulcer (ulcus vulvae acutum) – a rare cause of genital lesion. An Bras Dermatol. 2012;87(4):622-4. http://dx.doi.org/10.1590/S0365-05962012000400018. PMid:22892780.

13. Haidari G, MacMahon E, TongCY, White JA. Genital ulcers: it is not always simplex. Int J STD AIDS. 2015;26(1):72-3. http://dx.doi.org/10.1177/0956462414541241. PMid:24970475.

14. Pagano JS. Is Epstein-Barr virus transmitted sexually? J Infect Dis. 2007;195(4):469-70. http://dx.doi.org/10.1086/510861. PMid:17230404.

15. Taylor S, Drake SM, Dedicoat M, Wood MJ. Genital ulcers associated with acute Epstein-Barr virus infection. Sex Transm Infect. 1998;74(4):296-7. http://dx.doi.org/10.1136/sti.74.4.296. PMid:9924475.

16. Halvorsen JA, Breviq T, Aas T, Skar AG, Slevolden EM, Moi H. Genital ulcers as initial manifestation of EpsteinBarr virus infection: two new cases and a review of the literature. Acta Derm Venereol. 2006;86(5):439-42. http://dx.doi.org/10.2340/00015555-0140. PMid:16955191.

17. Miller S, Mateen FJ, Aksamit AJ Jr. Herpes simplex virus 2 meningitis: a retrospective cohort study. J Neurovirol. 2013;19(2):166-71. http://dx.doi.org/10.1007/s13365-013-0158-x. PMid:23494382.

18. Farazmand P, Woolley PD, Kinghorn GR. Mollaret’s meningitis and herpes simplex virus type 2 infections. Int STD AIDS. 2011;22(6):306-7. http://dx.doi.org/10.1258/ijsa.2010.010405. PMid:21680663.

19. Al-Araji A, Kidd DP. Neuro-Behçet’s disease: epidemiology, clinical characteristics, and management. Lancet Neurol. 2009;8(2):192-204. http://dx.doi.org/10.1016/S1474-4422(09)70015-8. PMid:19161910.


Publication date:
06/29/2016

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