*Correspondence: hl.justo@yahoo.com.
Abstract
Case Presentation: A.S.S., female, 1 year old, liver transplanted for cirrhosis secondary to biliary
atresia. History of Epstein-Barr virus infection. During hospitalization, the assistant
team observed right peripheral facial paralysis, then prescribed acyclovir and prednisolone
for 5 days, empirically, without resolution of the condition. A gradual decrease in
immunosuppression was chosen according to tolerance. On neurological examination,
the patient was in good general condition, clinical condition compatible with right
peripheral facial paralysis, she kept the cervical region preferably flexed to the
right, managed to close the eyes, but did not show resistance to passive opening of
the eyelid. Cranial magnetic resonance imaging showed thickening and contrast enhancement
inside the internal auditory canal and right cerebellopontine angle, as well as in
the trigeminal nerve on this side, nonspecific. Examination of the cerebrospinal fluid
showed: leukocytes 4/μL, erythrocytes 1/μL, total protein 19 mg/dL, lactate 1.47 mmol/L,
glucose 60 mg/dL, absence of bacterial growth, negative fungal and mycobacterial culture,
VDRL non-reactive and Epstein-Barr (EBV) positive.
Discussion: Peripheral facial palsy due to EBV in immunosuppressed children is infrequent. In
the reported case, the imaging exam suggested an inflammatory process compatible with
the clinical picture and the agent was identified by PCR in the cerebrospinal fluid.
Although the treatment of choice in immunosuppressed patients is rituximab, we decided
not to start it due to the low viral load. With the increase in viral load, treatment
with rituximab was started and 1 month after the start of treatment, the viral load
evolved with a decrease and the control neuroimaging no longer showed alterations.
Final Comments: In patients undergoing solid organ or hematopoietic cell transplantation, exposure
to EBV can be avoided by selecting donors without EBV contamination; However, this
is not always possible. Thus, patients are typically monitored for EBV infection,
and strategies to reduce the risk of post-transplant lymphoproliferative disease are
implemented if EBV viremia is detected.
