A 34-year-old male, previously healthy engineer, presented fever, urinary retention, weakness of the lower limbs and irregular sensory deficits in the chest and abdomen in the course of 24 hours.
The only antecedent was mild cough in the last 4-5 days before admission to the clinic.
An urological evaluation ruled out obstructive uropathy.
The neurological examination was alert, febrile (38°C), with no deficits in cranial nerves.
Strength in the upper limbs was normal, but moderate weakness in the lower limbs with inability to stand up from a sitting position was observed.
The plantar reflexes were extensors, there was sensory deficit in the posterior part of the neck and at the dermatome level D6.
Routine tests: blood count, sedimentation rate, C-reactive protein, hemocultive and urocultive were negative. CSF analysis showed 35 white blood cells per mm3, predominantly mononuclear cells.
Proteinorrhachia was 75 mg/dl. No oligoclonal bands were detected.
Detection of viral RNA by PCR-Microarray (Entherpex®, choleramic, Spain) was positive in CSF only for VHH-7.
Herpes virus HSV-1, HSV-2, HV-6, Epstein-acquired virus VZV, cytomegalovirus and also anterovirus were negative.
The test for HIV and HTLV-1 was negative, as well as immunological tests for vasculitis and serological test for Mycoplasma pneumoniae.
Magnetic resonance imaging (MRI) of the brain was normal and MRI of the spinal cord showed diffuse, extensive inflammatory lesions in the cervical and dorsal segments of the spinal cord (see Figures 1 and 2).
1.
Methylprednisolone 1 g daily was initiated for 3 days and ganvir iv 300 mg daily.
After 48 hours, the patient presented complete limb strength; urinary retention persisted for 1 month to resolve completely in the second month of follow-up.
CSF control at 10 days showed a negative PCR for Herpesviridae family viruses.
Fifteen cells with proteins in normal range were observed.
The repetition of CRP in the initial CSF sample taken at admission was also negative.
The discharge diagnosis was HHV-7-associated viral myelitis.
The controls after 6 months of evolution showed a healthy patient without signs of developing immunodeficiency.
