Burcu ÇALIŞKAN DEMİRKIRAN, Aysun YALÇI, Mine FİLİZ, Cumhur ARTUK, Cemal BULUT, İsmail Yaşar AVCI

İmmün Sağlam Bireyde HHV-7 İlişkili Geçici Splenial Lezyon ile Birlikte Hafif Ensefalit/Ensefalopati (MERS), Olgu Sunumu ve Literatür Taraması

Bilinen kronik hastalığı olmayan 26 yaşında erkek hasta ateş, baş ağrısı ve diplopi şikayetleri ile hastaneye başvurdu. Nörolojik muayenesi doğaldı ve meningeal irritasyon bulgusu yoktu. Beyin manyetik rezonans görüntülemede (MRG) korpus kallozum splenial bölgede hafif geçici sitotoksik lezyon (MERS-tip 1) görüldü. Beyin omurilik sıvısı (BOS) incelemesinde mononükleer pleositoz, artmış protein düzeyi ve insan herpes virüs-7 (HHV-7) DNA pozitifliği tespit edildi. BOS bulguları ile HSV-1 ensefalitine yönelik ampirik başlanan asiklovir tedavisi almaktayken klinik iyileşme gözlendi. Bu olguyu, immün sağlam bireyde hafif geçici splenial lezyon ile seyreden HHV-7 ensefaliti olgusu olduğu için sunmaya değer bulduk.

Mild Encephalitis/Encephalopathy With a Reversible Splenial Lesion (MERS) Associated With HHV-7 in a Immunocompetent Adult, A Case Report and Literature Review

A 26-year-old male without any chronic disease was admitted to the hospital with fever, headache and diplopia. Neurological examination was normal and there were no signs and symptoms of meningeal irritation. On brain magnetic resonance imaging (MRI), a mild transient cytotoxic lesion (MERS-type 1) was observed in the splenial region of the corpus callosum. Mononuclear pleocytosis, increased protein level and HHV-7 DNA positivity were detected in the cerebrospinal fluid (CSF) examination. Clinical improvement was observed while receiving empirical acyclovir treatment for HSV-1 encephalitis with CSF findings. We found this case worth presenting because there was an HHV-7 encephalitis case with mild transient splenial lesion in an immunocompetent individual.

PDF

___

1. Tada H, Takanashi J, Barkovich AJ, et al. Clinically mild encephalitis/ encephalopathy with a reversible splenial lesion. Neurology. 2004;63:1854- 1858.
2. Tuscano A, Zoppo M, Canavese C, et al. Transient blindness associated with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS): a case report and review of literature. Ital J Pediatr. 2020;46:152.
3. Mawatari M, Kobayashi T, Yamamoto S, et al. Mild encephalitis/ encephalopathy with a reversible splenial lesion due to plasmodium falciparum malaria: a case report. Trop Med Health. 2018;46:1-4.
4. Caselli E, Di Luca D. Molecular biology and clinical associations of Roseoloviruses human herpesvirus 6 and human herpesvirus 7. New Microbiol. 2007;30:173-187.
5. Chapenko S, Roga S, Skuja S, et al. Detection frequency of human herpesviruses-6A, -6B, and -7 genomic sequences in central nervous system DNA samples from post-mortem individuals with unspecified encephalopathy. J Neurovirol. 2016;22:488-497.
6. Aburakawa Y, Katayama T, Saito T, et al. Limbic Encephalitis Associated with Human Herpesvirus-7 (HHV-7) in an Immunocompetent Adult: The First Reported Case in Japan. Intern Med. 2017;56:1919-1923.
7. Riva N, Franconi I, Meschiari M, et al. Acute human herpes virus 7 (HHV- 7) encephalitis in an immunocompetent adult patient: a case report and review of literature. Infection. 2017;45:385-388.
8. Wyatt LS, Rodriguez WJ, Balachandran N, et al. Human herpesvirus 7: antigenic properties and prevalence in children and adults. J Virol. 1991;65:6260-6265.
9. Yuan J, Yang S, Wang S, et al. Mild encephalitis/encephalopathy with reversible splenial lesion (MERS) in adults-a case report and literature review. BMC Neurol. 2017;17:103.
10. Imamura T, Takanashi Jİ, Yasug J, et al. Sisters with clinically mild encephalopathy with a reversible splenial lesion (MERS)-like features; familial MERS? J Neurol Sci. 2010;290:153-156.
11. Tascilar N, Aydemir H, Emre U, et al. Unusual combination of reversible splenial lesion and meningitis-retention syndrome in aseptic meningomyelitis. Clinics (Sao Paulo). 2009;64:932-7.
12. Tascilar N, Aydemir H, Emre U, et al. Unusual combination of reversible splenial lesion and meningitis-retention syndrome in aseptic meningomyelitis. Clinics (Sao Paulo). 2009;64:932-937.
13. Degirmenci E, Degirmenci T, Cetin EN, et al. Mild encephalitis/ encephalopathy with a reversible splenial lesion (MERS) in a patient presenting with papilledema. Acta Neurol Belg. 2015;115:153-155.
14. Avcu G, Kilinc MA, Eraslan C, et al. Mild encephalitis/encephalopathy with reversible spleniallesion (MERS) associated with Streptococcus pneumoniae Bacteraemia. J Infect Public Health. 2017;10:479-482.
15. Bulakbasi N, Kocaoglu M, Tayfun C, et al. Transient splenial lesion of the corpus callosum in clinically mild influenza-associated encephalitis/ encephalopathy. AJNR Am J Neuroradiol. 2006;27:1983-1986.
16. Yıldız AE, Maraş Genç H, Gürkaş E, et al. Mild encephalitis/encephalopathy with a reversible splenial lesion in children. Diagn Interv Radiol. 2018;24:108- 112.
17. Shi BC, Li J, Jiang JW, et al. Mild encephalitis/encephalopathy with a reversible splenial lesion secondary to encephalitis complicated by hyponatremia: A case report and literature review. Medicine (Baltimore). 2019;98:e17982.
18. Hayashi M, Sahashi Y, Baba Y, et al. COVID-19-associated mild encephalitis/ encephalopathy with a reversible splenial lesion. J Neurol Sci. 2020;415:116941.
19. Hoshino A, Saitoh M, Oka A, et al. Epidemiology of acute encephalopathy in Japan, with emphasis on the association of viruses and syndromes. Brain Dev. 2012;34:337-343.
20. Hashimoto Y, Takanashi J, Kaiho K, et al. A splenial lesion with transiently reduced diffusion in clinically mild encephalitis is not always reversible: A case report. Brain Dev. 2009;31:710-712.
21. Ueda N, Minami S, Akimoto M. Mycoplasma pneumoniae-associated mild encephalitis/encephalopathy with a reversible splenial lesion: report of two pediatric cases and a comprehensive literature review. BMC Infect Dis 2016;16:671.