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809: AN UNUSUAL PRESENTATION OF EBV MENINGOENCEPHALITIS

Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives: Ebstein Barr Virus (EBV) infection is common and usually causes mild, self-limited infection in children. EBV-related neurologic manifestations, including aseptic meningitis, encephalitis, cerebellitis, transverse myelitis, and seizures, are rare. These manifestations can occur alone or in conjunction with the clinical picture of primary EBV infection. Here we report a unique presentation of EBV meningoencephalitis complicated by status epilepticus in an immunocompetent child. Methods: A 2 year old healthy female presented with 7 days of fever and associated petechial rash, mucosal changes, and cervical lymphadenopathy. Shortly after admission, she developed status epilepticus originating from the right temporal lobe. Benzodiazepines, Fosphenytoin, and Phenobarbital were required for seizure resolution. CT was concerning for diffuse cerebral edema. CSF examination showed a lymphocytic pleocytosis and empiric treatment with Vancomycin, Ceftriaxone, and Acyclovir was initiated. Given concern for Atypical Kawasaki’s, IVIG was given. MRI revealed multifocal areas of signal abnormality throughout the cortical and central gray matter. Cultures remained negative and empiric antibiotics were discontinued. Viral testing for Enterovirus, Parechovirus, and HSV were negative. EBV PCR was positive from the CSF. Serum evaluation was also consistent with primary EBV infection. Anti-viral therapy was not continued. The patient’s course was complicated by bradycardia and hypertension from encephalitis-related dysautonomia. She showed gradual improvement with no further seizures, however demonstrated mild impairments in mobility and feeding at discharge. She was continued on Levetiracetam. At 2 month Physical Medicine and Rehabilitation follow-up, she had no residual deficits and a normal neurologic exam. Results: This case illustrates an unusual presentation of primary EBV infection with meningoencephalitis, status epilepticus, and transient autonomic dysfunction. Presentation of EBV infection is not always easily recognized or characterized by the classic symptoms. EBV meningoencephalitis must be considered in the setting of unexplained neurologic symptoms, especially in the presence of viral symptoms. Despite radiographic evidence of diffuse cerebral involvement, patients can have a limited disease course with favorable outcome.