背景:传染性单核细胞增多症在儿童时期非常常见,神经系统表现极为罕见。然而,当它们发生时,必须进行适当的治疗,以降低发病率和死亡率,并确保适当的管理。
方法:我们描述了一名EBV后急性小脑共济失调的女性患者的临床和神经系统记录,通过静脉注射免疫球蛋白治疗,其症状迅速缓解。之后,我们将我们的结果与已发表的数据进行了比较.
结果:我们报道了一个有5天突然虚弱病史的青春期女性病例,呕吐,头晕,脱水,单斑试验阳性和高转氨酶血症.在接下来的日子里,她出现了急性共济失调,困倦,眩晕,EBVIgM滴度阳性的眼球震颤,确认急性传染性单核细胞增多症。患者临床诊断为EBV相关急性小脑炎。脑部MRI显示无急性变化,CT扫描显示肝脾肿大。她开始用阿昔洛韦和地塞米松治疗。几天后,因为她的病情恶化,她接受了静脉注射免疫球蛋白,并表现出良好的临床反应。
结论:虽然目前尚无治疗感染后急性小脑共济失调的共识指南,静脉注射免疫球蛋白的早期干预可能会预防不良结局,特别是在对高剂量类固醇治疗没有反应的情况下。
BACKGROUND: infectious mononucleosis is very common during childhood and neurological manifestations are extremely rare. However, when they occur, an appropriate treatment must be undertaken to reduce morbidity and mortality as well as to ensure appropriate management.
METHODS: we describe the clinical and neurological records of a female patient with post-EBV acute cerebellar ataxia, whose symptoms rapidly resolved with intravenous immunoglobulin therapy. Afterwards, we compared our results with published data.
RESULTS: we reported the case of an adolescent female with a 5-day history of sudden asthenia, vomiting, dizziness, and dehydration, with a positive monospot test and hypertransaminasemia. In the following days, she developed acute ataxia, drowsiness, vertigo, and nystagmus with a positive EBV IgM titer, confirming acute infectious mononucleosis. The patient was clinically diagnosed with EBV-associated acute cerebellitis. A brain MRI showed no acute changes and a CT scan showed hepatosplenomegaly. She started therapy with acyclovir and dexamethasone. After a few days, because of her condition\'s deterioration, she received intravenous immunoglobulin and demonstrated a good clinical response.
CONCLUSIONS: although there are no consensus guidelines for the treatment of post-infectious acute cerebellar ataxia, early intervention with intravenous immunoglobulin might prevent adverse outcomes, especially in cases that do not respond to high-dose steroid therapy.