A 41 year-old man, recently returned from Thailand, presented with bilateral shoulder pain and weakness, fever greater than 38 degrees and coryzal symptoms. He had no significant past medical history. He had abnormal liver function tests and an abnormal electromyogram of his right upper limb. He was diagnosed with acute Epstein Barr virus infection, however cerebrospinal fluid was negative for the virus. At follow up after three months, the patient had persistent weakness of his right upper limb. The literature suggests neurological features present in up to 7.5% of patients with Epstein Barr virus, although argues this is underestimated with the virus often being overlooked as a cause of neurological symptoms.

[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

1. Yu S, Wang J, Fang Q, et al; Specific clinical manifestations of Nocardia: A case report and literature review. Experimental and Therapeutic Medicine 2016; 12:2021-2026
2. Zheng YC, Wang TL, Hsu JC, et al; Clinical Pathway in the Treatment of Nocardial Brain Abscesses following Systemic Infections. Case Reports in Neurological Medicine 2014; 2014:1-8
3. Lin YJ, Yang KY, Ho JT, et al; Nocardial brain abscess. Journal of Clinical Neuroscience 2010; 17(2):250-253
4. Byrne E, Brophy P, Perrett IV; Nocardia cerebral abscess: new concepts in diagnosis, management, and prognosis. Journal of Neurology, Neurosurgery, and Psychiatry 1979; 42:1038-1045
5. Yasar Z, Acat M, Onaran H, et al; An Unusual Case of Pulmonary Nocardiosis in Immunocompetent Patient. Case Reports in Pulmonology 2014; 2014 (1-4)
6. Wilson JW; Nocardiosis: Updates and Clinical Overview. Mayo Clin Proc. 2012; 87(4):403-407
7. Tang H, Mao T, Gong Y, et al; Nocardial brain abscess in an immunocompromised old patient: a case report and review of literature. Int J Clin Exp Med 2014; 7(5):1480-1482
8. Lee GY, Daniel RT, Brophy BP, et al; Surgical treatment of nocardial brain abscesses. Neurosurgery 2002; 51:668–71
9. Zhang Y, Zhu W, Li Q, et al; Nocardial brain abscess in an immunocompetent patient and review of literature. Chinese Neurosurgical Journal 2016; 2:26
10. Mamelak AN, Obana WG, Flaherty JF, et al; Nocardial brain abscess: treatment strategies and factors influencing outcome. Neurosurgery 1994; 35(4):622-31
11. Xu Q, Zhan R, Feng Y, et al; Successful Treatment of Multifoci Nocardial Brain Abscesses: A Case Report. Medicine (Baltimore) 2015; 94(19): e848
12. Tamarit M, Poveda P, Barón M, et al; Four cases of brain abscess. Surg Neurol Int. 2012; 3:88