2021 Volume 114 Issue 3 Pages 183-187
Infectious mononucleosis is a viral syndrome that is most often caused by Epstein-Barr virus (EBV). A few patients, at the time of the initial infection with EBV, reportedly manifest neurological symptoms, such as meningitis, Guillain-Barré syndrome, and encephalitis. We report a case of infectious myelitis in association with infectious mononucleosis caused by EBV. The patient was a 23-year-old woman who presented with persistent sore throat, fever, and cervical lymphadenopathy. Examination revealed bilateral tonsillar hypertrophy with redness and pus discharge. After making a diagnosis of infectious mononucleosis based on the laboratory data and findings of physical examination, we treated the patient with antibiotics. On the fourth day after the initiation of treatment, the patient showed unilateral motor and sensory paralysis of acute onset. Cervical MRI revealed high signal intensities in the C5 section of the spinal cord. Neurologists at our institution began the patient on pulse therapy with methylprednisolone. After two courses of steroid pulse therapy, the motor and sensory paralysis improved. Cerebrospinal fluid examination revealed a negative test result for EBV-DNA, but the patient was diagnosed as having infectious myelitis caused by EBV from the clinical course.
Although infectious mononucleosis is encountered frequently by otolaryngologists, care should be taken to watch out for the development of hidden complications in patients with acute tonsillitis presenting with atypical findings, such as neurologic symptoms.
