Cerebral meningitis due to tuberculoma and epstein barr: presentation of a clinical case
DOI:
https://doi.org/10.62486/agmu202448Keywords:
Epstein-Barr virus infections, encephalitis, meningitis, mycobacterium tuberculosis, spectroscopy, tuberculomaAbstract
Neuroinfection is an inflammatory process that affects the meninges or brain parenchyma; it has various etiologies, including viral and non-viral, including autoimmune, bacterial and fungal; patients with this pathology represent a challenge for doctors; the severity varies, from benign, self-limiting to life-threatening. The Epstein-Barr virus (EBV) is a double-stranded DNA gamma herpesvirus that presents a latent infection and lytic replication; it can diffuse into the central nervous system and alter the integrity of the blood-brain barrier, being associated with neurocognitive impairment, neuronal damage and inflammation. In relation to tuberculosis, it became the second infectious disease that caused the most deaths in the world after COVID-19; tuberculous meningitis is considered the most severe form of extrapulmonary tuberculosis (TB) with a mortality of 70% in low-income countries. Below is the case of a 35-year-old man with a history of adrenal insufficiency and hyperthyroidism, who was receiving corticosteroids; he went to the emergency service with a 5-month history of clinical symptoms characterized by holocranial headache, focal retrograde amnesia, periods of altered state of consciousness, dizziness, nausea that led to vomiting on several occasions, with sudden loss of consciousness. , accompanied by involuntary tonic-clonic movements and hearing loss; after the diagnostic screening, EBV and TB are identified; receives specific treatment with good clinical evolution
References
Jones LK Jr. Neurocritical Care and the Death of Therapeutic Nihilism. Continuum (Minneap Minn). 2024 Jun 1;30(3):554-555. doi: 10.1212/CON.0000000000001460. Continuum (minneap minn) 2024;30(3, neurocritical care): 757–780. DOI: https://doi.org/10.1212/CON.0000000000001460
Rohani H, Arjmand R, Mozhgani S, Shafiee A, Javad Amini M, Forghani-Ramandi M. The worldwide prevalence of herpes simplex virus encephalitis and meningitis: A systematic review and meta-analysis. Turk Arch Pediatr. 2023;58(6):580-587. http://dx.doi.org/10.5152/turkarchpediatr.2023.23007 DOI: https://doi.org/10.5152/TurkArchPediatr.2023.23007
Mount HR, Boyle SD. Aseptic and Bacterial Meningitis: Evaluation, Treatment, and Prevention. Am Fam Physician. 2017 Sep 1;96(5):314-322. https://pubmed.ncbi.nlm.nih.gov/28925647/
Moule MG, Cirillo JD. La diseminación de Mycobacterium tuberculosis juega un papel crítico en la patogénesis. Front Cell Infect Microbiol [Internet]. 2020 ;10. Disponible en: http://dx.doi.org/10.3389/fcimb.2020.00065 DOI: https://doi.org/10.3389/fcimb.2020.00065
Situación de la Tuberculosis en las Américas [Internet]. Paho.org. [citado el 20 de agosto de 2024]. Disponible en: https://www.paho.org/es/temas/tuberculosis/situacion-tuberculosis-americas
Zürcher K, Ballif M, Kiertiburanakul S, Chenal H, Yotebieng M, Grinsztejn B, et al. Diagnóstico y resultados clínicos de la tuberculosis extrapulmonar en programas de terapia antirretroviral en países de ingresos bajos y medios: un estudio multicohorte. J Int AIDS Soc [Internet]. 2019;22(9). Disponible en: http://dx.doi.org/10.1002/jia2.25392 DOI: https://doi.org/10.1002/jia2.25392
Behr MA, Edelstein PH, Ramakrishnan L. Revisiting the timetable of tuberculosis. BMJ [Internet]. 2018; k2738. Disponible en: http://dx.doi.org/10.1136/bmj.k2738 DOI: https://doi.org/10.1136/bmj.k2738
Zhang N, Zuo Y, Jiang L, Peng Y, Huang X, Zuo L. Epstein-Barr virus and neurological diseases. Front Mol Biosci [Internet]. 2022;8. Disponible en: http://dx.doi.org/10.3389/fmolb.2021.816098 DOI: https://doi.org/10.3389/fmolb.2021.816098
Cohen, Jeffrey I. "Infecciones causadas por el virus de Epstein-Barr, incluida mononucleosis infecciosa." Harrison. Principios de Medicina Interna, 20e Eds. J. Larry Jameson, et al. McGraw-Hill Education,2018, https://accessmedicina.mhmedical.com/content.aspx?bookid=2461§ionid=209900925.
Wong Y, Meehan MT, Burrows SR, Doolan DL, Miles JJ. Estimating the global burden of Epstein–Barr virus-related cancers. J Cancer Res Clin Oncol [Internet]. 2022 ;148(1):31–46. Disponible en: http://dx.doi.org/10.1007/s00432-021-03824-y DOI: https://doi.org/10.1007/s00432-021-03824-y
Portegies P, Corssmit N. Epstein-Barr virus and the nervous system. Curr Opin Neurol. 2000;13(3):301-304. doi:10.1097/00019052-200006000-00012 DOI: https://doi.org/10.1097/00019052-200006000-00012
Leuci S, Coppola N, Cantile T, Calabria E, Mihai LL, Mignogna MD. Aseptic meningitis in oral medicine: Exploring the key elements for a challenging diagnosis: A review of the literature and two case reports. Int J Environ Res Public Health [Internet]. 2022;19(7):3919. Disponible en: http://dx.doi.org/10.3390/ijerph19073919 DOI: https://doi.org/10.3390/ijerph19073919
Kumar R. Understanding and managing acute encephalitis. F1000Res [Internet]. 2020;9:60. Disponible en: http://dx.doi.org/10.12688/f1000research.20634.1 DOI: https://doi.org/10.12688/f1000research.20634.1
Shukla B, Aguilera EA, Salazar L, Wootton SH, Kaewpoowat Q, Hasbun R. Aseptic meningitis in adults and children: Diagnostic and management challenges. J Clin Virol. 2017 Sep;94:110-114. doi: 10.1016/j.jcv.2017.07.016. Epub 2017 Aug 4. DOI: https://doi.org/10.1016/j.jcv.2017.07.016
Tattevin P, Tchamgoué S, Belem A, Bénézit F, Pronier C, Revest M. Aseptic meningitis. Rev Neurol (Paris) [Internet]. 2019;175(7–8):475–80. Disponible en: http://dx.doi.org/10.1016/j.neurol.2019.07.005 DOI: https://doi.org/10.1016/j.neurol.2019.07.005
Rock RB, Olin M, Baker CA, Molitor TW, Peterson PK. Tuberculosis del sistema nervioso central: patogénesis y aspectos clínicos. Clin Microbiol Rev [Internet]. 2008;21(2):243–61. Disponible en: http://dx.doi.org/10.1128/cmr.00042-07 DOI: https://doi.org/10.1128/CMR.00042-07
Hwang JH, Lee KM, Park JE, Kim H-G, Kim EJ, Choi WS, et al. Atypical Cerebral Manifestations of Disseminated Mycobacterium tuberculosis. Front Neurol [Internet]. 2017;8. Disponible en: http://dx.doi.org/10.3389/fneur.2017.00462 DOI: https://doi.org/10.3389/fneur.2017.00462
Bovijn, L., Solomons, R., Marais, S. (2019). Tuberculosis neurológica en el VIH. En: Sereti, I., Bisson, GP, Meintjes, G. (eds) VIH y tuberculosis. Springer, Cham. https://doi.org/10.1007/978-3-030-29108-2_13 DOI: https://doi.org/10.1007/978-3-030-29108-2_13
Schaller, MA, Wicke, F., Foerch, C. et al. Tuberculosis del sistema nervioso central. Clin Neuroradiol 29 , 3–18 (2019). https://doi.org/10.1007/s00062-018-0726-9 DOI: https://doi.org/10.1007/s00062-018-0726-9
De Lance AR, Safaee M, Oh MC, Clark AJ, Kaur G, Sun MZ, et al. Tuberculoma of the central nervous system. J Clin Neurosci [Internet]. 2013;20(10):1333–41. Disponible en: http://dx.doi.org/10.1016/j.jocn.2013.01.008 DOI: https://doi.org/10.1016/j.jocn.2013.01.008
Majós C. Espectroscopia por resonancia magnética de protón en el diagnóstico de tumores cerebrales. Radiologia [Internet]. 2005;47(1):1–12. Disponible en: http://dx.doi.org/10.1016/s0033-8338(05)72790-9 DOI: https://doi.org/10.1016/S0033-8338(05)72790-9
Nahid P, Dorman SE, Alipanah N, Barry PM, Brozek JL, Cattamanchi A, et al. Official American thoracic society/Centers for Disease Control and Prevention/Infectious Diseases Society of America clinical practice guidelines: Treatment of drug-susceptible tuberculosis. Clin Infect Dis [Internet]. 2016;63(7):e147–95. Disponible en: http://dx.doi.org/10.1093/cid/ciw376 DOI: https://doi.org/10.1093/cid/ciw376
Andersen O, Ernberg I, Hedström AK. Treatment options for Epstein-Barr virus-related disorders of the central nervous system. Infect Drug Resist [Internet]. 2023;16:4599–620. Disponible en: http://dx.doi.org/10.2147/idr.s375624 DOI: https://doi.org/10.2147/IDR.S375624
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