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Título

ENCEPHALITIS ASSOCIATED WITH PARVOVIRUS B19 INFECTION: A CASE REPORT

Resumo

Case presentation: A 62-year-old female patient was admitted to the emergency department with epigastric pain, hypoactivity, fever, chills, nausea, arthralgia and decreased consciousness for 2 days. Two days later, she evolved with headache, vomiting, decreased level of consciousness and tonic-clonic seizure. Petechial rash, papules, livedo reticularis, hyperemia and jaundice were also present. Head MRI and EEG were normal. Cerebrospinal fluid (CSF) analysis revealed xanthochromia, hyperproteinorrachia (98 mg/dL), normal glucose (66 mg/dL), 21 cells/m3 (69% neutrophils; 10% macrophages). Diagnosis of meningoencephalitis was made. Empirical treatment with ceftriaxone, ampicillin and acyclovir was initiated. Serologic tests for Zika, Dengue, CHIKV, HIV, VDRL and hepatitis were negative. Acute renal failure, septic shock, leukocytosis (27.350), thrombocytopenia developed rapidly, and the patient was transferred to the ICU. She woke up 12 days later, with delirium, diffuse weakness and mild right VI and VII cranial nerve palsy. New CSF was collected which remained xanthochromic and showed hyperproteinorrachia (138 mg/dL), glucose of 83 mg/dL and 23 cells/m3 (77% lymphocytes; 18% macrophages). XGEN MULTI N9 PCR was performed on CSF for Varicella zoster, HSV 1, 2, 6 and 7, CMV, EBV, enterovirus, adenovirus, parechovirus and parvovirus (PVB19) and only PVB19 was positive. EBV was detectable (296 IU/mL) by PCR in serum. Six days later, the CSF showed reduced cellularity (4 cells/m3) and proteinorrachia (92 mg/dL). There was improvement on neurological examination with normal cognition and mild generalized weakness. She was then referred for physical rehabilitation. After 2 months she returned to clinical office with normal neurological examination.
Discussion and conclusion: The most frequent clinical presentation of PVB19 infection is erythema infectiosum, a self-limited disease which is very common in children. Encephalitis due to PVB19 infection is uncommon and should be considered in cases of encephalitis whose main etiologies have been ruled out. When available, multiplex-PCR should be performed, as it allows for a faster and wider etiological diagnosis.

Palavras Chave

Meningoencephalitis; Parvovirus B19