RESUMO
We present a patient with systemic symptoms including 4 months of dyspnoea worsened with exertion, fatigue, rhinorrhoea, intermittent facial swelling, generalised lymphadenopathy and weight loss. Laboratory studies demonstrated proteinuria and eosinophilia. His serology was consistent with Epstein-Barr Virus (EBV) reactivation. A lymph node biopsy was consistent with EBV-associated reactive lymphoid hyperplasia. He was told to continue symptomatic treatment for EBV infection. After several admissions, vasculitis workup and myeloperoxidase-antineutrophil cytoplasmic autoantibody (ANCA) studies were positive. Evolution of clinical symptoms, laboratory parameters and our literature review suggested the diagnosis of EBV-associated ANCA vasculitis. Steroids were started after the patient continued to deteriorate; the viral load started increasing, so we added valganciclovir with favourable clinical response and no relapse during the follow-up for 6 months. This suggests that with evidence of viraemia (primary or reactivation), antiviral treatment likely has clinical benefit while immunosuppression is being considered.
Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos , Infecções por Vírus Epstein-Barr , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Anticorpos Anticitoplasma de Neutrófilos , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/diagnóstico , Infecções por Vírus Epstein-Barr/tratamento farmacológico , Herpesvirus Humano 4 , Humanos , Masculino , PeroxidaseAssuntos
Hepatite/microbiologia , Sífilis/diagnóstico , Sífilis/patologia , Treponema pallidum/isolamento & purificação , Adulto , Colestase/diagnóstico , Colestase/patologia , Exantema/diagnóstico , Exantema/patologia , Hepatite/complicações , Hepatite/patologia , Humanos , Imuno-Histoquímica , Masculino , Microscopia , Sífilis/complicações , Uveíte/diagnóstico , Uveíte/patologiaRESUMO
West Nile virus infection can result in prolonged subjective complaints of cognitive and functional decline even in the absence of a neuroinvasive form of infection. Persistent cognitive and functional complaints could be a result of general somatic symptoms, emotional distress, or residual central nervous system damage or dysfunction. Most studies of cognition in postacute West Nile virus infection rely on self-report. This descriptive study aimed to document cognitive deficits in a sample of the 2003 infected population reported in New Mexico. Patients with clinically defined neuroinvasive disease or who were impaired on brief mental status screening were seen for comprehensive neuropsychological assessment. We found that one year after symptom onset, more than half of the sample had objectively measurable neuropsychological impairment in at least two cognitive domains. Impairment was not related to subjective complaints of physical or emotional distress, or premorbid intellectual abilities. Persistent cognitive impairment in West Nile virus infection may be due to prolonged or permanent damage to the central nervous system.
Assuntos
Transtornos Cognitivos/etiologia , Transtornos Cognitivos/virologia , Febre do Nilo Ocidental/complicações , Vírus do Nilo Ocidental/patogenicidade , Adulto , Idoso , Atenção , Função Executiva , Feminino , Humanos , Masculino , Memória , Pessoa de Meia-Idade , Testes Neuropsicológicos , New Mexico , Desempenho Psicomotor , Estudos RetrospectivosRESUMO
West Nile virus (WNV) myocarditis has been documented pathologically in birds and mammals but has rarely been reported in human clinical syndromes. We describe myocarditis associated with WNV.
Assuntos
Miocardite/virologia , Febre do Nilo Ocidental/diagnóstico , Idoso , Doenças dos Animais , Animais , Aves/virologia , Humanos , Masculino , Mamíferos/virologia , Miocardite/veterináriaRESUMO
Mental status after acute West Nile virus infection has not been examined objectively. We compared Telephone Interview for Cognitive Status scores of 116 patients with West Nile fever or West Nile neuroinvasive disease. Mental status was poorer and cognitive complaints more frequent with West Nile neuroinvasive disease (p = 0.005).