A 60-year-old woman was admitted to our hospital because of
pyrexia,
headache, gait disturbance, and sensory disturbance in the lower part of the body four days after she received an epidural block for
postherpetic neuralgia. Neurological tests revealed neck stiffness, flaccid
paraparesis in the legs with absent deep tendon reflexes, and
hyperesthesia below Th7. According to a cerebrospinal fluid examination, the
protein concentration was 245 mg/dl and the cell count was 176/mm3. PCR analysis of the cerebrospinal fluid was positive for Epstein-Barr virus (EBV). Serological tests for EBV yielded mild increases of serum
IgG antibodies against
EBV nuclear antigen (EBNA) and
IgG antibodies against EBV viral capsid
antigen (VCA). In a spinal MRI, the inferior lumbar meninges showed
gadolinium enhancement. Nerve conduction studies revealed a decreased F wave ratio in the bilateral tibial nerves. The patient was diagnosed with meningomyeloradiculitis caused by EBV. The symptoms improved after
steroid pulse
therapy, but relapses of
transverse myelitis and
diplopia due to disturbance of the bilateral abducent nerves and left trochlear nerve occurred 7, 12, 16, and 26 months
after treatment. The relapses were sometimes accompanied by small fluctuations in cerebrospinal fluid
protein concentration, cell count, or serum anti-EBV antibody titer. These findings suggest that the
myelopathy and
diplopia were induced by a secondary immune reaction after
inflammation caused by
EBV infection.