Epstein–Barr virus encephalitis following unrelated peripheral blood stem cell transplantation in a child with AML

Abstract

Herein, we report a case of Epstein–Barr virus (EBV) brainstem encephalitis after unrelated peripheral blood stem cell transplantation (uPBSCT), the distinctive radiological features of which enabled early diagnosis and intervention. A 13-year-old boy with FLT3-ITD-positive acute myeloid leukemia underwent HLA-DR1 antigen one locus mismatched uPBSCT with pretreatment including anti-thymocyte globulin (ATG). On post-transplant day 104, the patient had an altered consciousness. Cranial magnetic resonance imaging revealed bilateral hyperintensities in the thalamus, hypothalamus, internal capsule, parahippocampal gyrus, and midbrain to medulla oblongata, whereas peripheral blood examination revealed a high percentage of CD20-positive lymphocytes, suggesting EBV encephalitis. Accordingly, rituximab was initiated, which was effective. The patient was later found to be positive for EBV-DNA in blood and cerebrospinal fluid samples. The patient recovered without any neurological sequelae. Caution should be exercised in similar cases with an increase in ATG conditioning due to the diversification of donor sources.