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 |