Epstein-Barr virus encephalitis in a patient with rheumatoid arthritis.
Jun NakamuraMai YanagidaKeisuke SaitoYasuyuki KamataTakao NagashimaMasahiro IwamotoTakeo SatoKojiro SatoPublished in: Modern rheumatology case reports (2022)
A 53-year-old woman with a 6-year history of rheumatoid arthritis (RA) presented with pharyngeal pain, fever, and altered mental status. The patient had been treated with methotrexate (MTX) 12 mg/week, baricitinib 4 mg/day, and tacrolimus 2 mg/day. Magnetic resonance imaging of the brain revealed diffuse high-intensity lesions in the cerebral white matter, basal ganglia, brainstem, and right cerebellar hemisphere. She was diagnosed with Epstein-Barr virus (EBV) encephalitis due to elevated levels of EBV-DNA in the cerebrospinal fluid and serum. Although MTX-associated lymphoproliferative disorders are well-known complications in patients with RA, EBV encephalitis requires careful attention for such patients undergoing treatment with multiple potent immunosuppressants.
Keyphrases
- epstein barr virus
- rheumatoid arthritis
- high intensity
- white matter
- disease activity
- diffuse large b cell lymphoma
- magnetic resonance imaging
- cerebrospinal fluid
- patients undergoing
- ankylosing spondylitis
- case report
- interstitial lung disease
- resistance training
- chronic pain
- multiple sclerosis
- systemic lupus erythematosus
- neuropathic pain
- pain management
- working memory
- subarachnoid hemorrhage
- mental health
- risk factors
- resting state
- spinal cord injury
- brain injury
- low grade
- cerebral ischemia
- circulating tumor
- magnetic resonance
- clinical trial
- systemic sclerosis
- spinal cord
- low dose
- combination therapy
- body composition
- functional connectivity
- replacement therapy