{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:08:30Z","timestamp":1789578510095,"version":"build-2803163510"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T00:00:00Z","timestamp":1614211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013076","name":"National Major Science and Technology Projects of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013076","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004731","name":"Natural Science Foundation of Zhejiang Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004731","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Encephalitis caused by Epstein-Barr virus infection is uncommon, but most patients have a good outcome after symptomatic treatment. The infiltration of mononuclear cells in blood vessels and necrosis resulting from the immune response to Epstein-Barr virus infection in a very small number of patients seem to be the main cause of death. We describe a fatal case of Epstein-Barr virus encephalitis diagnosed by next-generation sequencing in an immune-competent adult but progressed to brainstem hemorrhage.<\/jats:p>","DOI":"10.3389\/fimmu.2021.618830","type":"journal-article","created":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T09:22:00Z","timestamp":1614244920000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":32,"title":["Case Report: Epstein\u2013Barr Virus Encephalitis Complicated With Brain Stem Hemorrhage in an Immune-Competent Adult"],"prefix":"10.3389","volume":"12","author":[{"given":"Lingtong","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueling","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,2,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-11-281","article-title":"Clinical characteristics of patients with Epstein Barr virus in cerebrospinal fluid","volume":"11","author":"Martelius","year":"2011","journal-title":"BMC Infect Dis"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2010.029876","article-title":"Viral encephalitis after allogeneic stem cell transplantation: a rare complication with distinct characteristics of different causative agents","volume":"96","author":"Schmidt-Hieber","year":"2011","journal-title":"Haematologica"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1111\/tid.12431","article-title":"Epstein-Barr virus encephalitis in a renal transplant recipient manifesting as hemorrhagic, ring-enhancing mass lesions","volume":"17","author":"Babik","year":"2015","journal-title":"Transpl Infect Dis"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2014.01.018","article-title":"Cerebral vasculitis and encephalitis due to Epstein-Barr virus in a patient with newly diagnosed HIV infection","volume":"59","author":"Raman","year":"2014","journal-title":"J Clin Virol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3851\/IMP2451","article-title":"Successful treatment of Epstein-Barr virus encephalitis in the setting of HIV-associated neurocognitive disorder: a diagnostic and therapeutic challenge","volume":"18","author":"Trevillyan","year":"2013","journal-title":"Antivir Ther"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3280b07784","article-title":"Intravenous ganciclovir consistently induces remission of persistent Epstein-Barr encephalitis in an HIV-1-infected patient","volume":"21","author":"Katramados","year":"2007","journal-title":"AIDS"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1086\/324350","article-title":"Focal neurological disease in patients with acquired immunodeficiency syndrome","volume":"34","author":"Skiest","year":"2002","journal-title":"Clin Infect Dis"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.nrl.2015.03.016","article-title":"Optic neuritis following Epstein-Barr virus encephalitis in immunocompetent children: A case report","volume":"32","author":"Bazzino Rubio","year":"2017","journal-title":"Neurologia"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-004-0930-3","article-title":"Acute hemorrhagic leukoencephalitis (Hurst\u2019s disease) linked to Epstein-Barr virus infection","volume":"109","author":"Hofer","year":"2005","journal-title":"Acta Neuropathol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1007\/s13365-018-0718-1","article-title":"A case of fulminant Epstein-Barr virus encephalitis in an immune-competent adult","volume":"25","author":"Koning","year":"2019","journal-title":"J Neurovirol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.ijid.2015.11.009","article-title":"Transient widespread cortical and splenial lesions in acute encephalitis\/encephalopathy associated with primary Epstein-Barr virus infection","volume":"42","author":"Zhang","year":"2016","journal-title":"Int J Infect Dis"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2006.09.007","article-title":"Basal ganglia and brainstem encephalitis, optic neuritis, and radiculomyelitis in Epstein-Barr virus infection","volume":"54","author":"Phowthongkum","year":"2007","journal-title":"J Infect"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1086\/323008","article-title":"Encephalitis caused by Epstein-Barr virus in a renal transplant recipient","volume":"34","author":"Garamendi","year":"2002","journal-title":"Clin Infect Dis"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.4103\/0028-3886.84347","article-title":"Epstein Barr virus encephalitis: clinical diversity and radiological similarity","volume":"59","author":"Kalita","year":"2011","journal-title":"Neurol India"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1080\/13550280490521050","article-title":"Acute fatal necrotizing hemorrhagic encephalitis caused by Epstein-Barr virus in a young adult immunocompetent man","volume":"10","author":"Francisci","year":"2004","journal-title":"J Neurovirol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-011-0228-5","article-title":"Rhombencephalitis \/ brainstem encephalitis","volume":"11","author":"Jubelt","year":"2011","journal-title":"Curr Neurol Neurosci Rep"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1007\/BF02012744","article-title":"Fatal brainstem encephalitis caused by Epstein-Barr virus","volume":"24","author":"Shian","year":"1994","journal-title":"Pediatr Radiol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-003-0977-4","article-title":"Thalamic involvement of Epstein-Barr virus encephalitis demonstrated by MRI","volume":"250","author":"Johkura","year":"2003","journal-title":"J Neurol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-007-0619-3","article-title":"Serial diffusion-weighted MR imaging findings in a patient with Epstein-Barr virus encephalitis","volume":"254","author":"Kim","year":"2007","journal-title":"J Neurol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1002\/mds.23935","article-title":"Reversible parkinsonism due to involvement of substantia nigra in Epstein-Barr virus encephalitis","volume":"27","author":"Guan","year":"2012","journal-title":"Mov Disord"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2005.11.004","article-title":"Reversible Parkinsonian syndrome associated with anti-neuronal antibodies in acute EBV encephalitis: a case report","volume":"12","author":"Roselli","year":"2006","journal-title":"Parkinsonism Relat Disord"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofy114","article-title":"Real-time Utilization of Metagenomic Sequencing in the Diagnosis and Treatment Monitoring of an Invasive Adenovirus B55 Infection and Subsequent Herpes Simplex Virus Encephalitis in an Immunocompetent Young Adult","volume":"5","author":"Fang","year":"2018","journal-title":"Open Forum Infect Dis"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.37.9.2852-2857.1999","article-title":"Monitoring of epstein-barr virus DNA load in peripheral blood by quantitative competitive PCR","volume":"37","author":"Stevens","year":"1999","journal-title":"J Clin Microbiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e245","DOI":"10.1212\/NXI.0000000000000245","article-title":"CSF herpes virus and autoantibody profiles in the evaluation of encephalitis","volume":"3","author":"Linnoila","year":"2016","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1111\/ene.13332","article-title":"Anti-N-methyl-D-aspartate receptor encephalitis and Epstein-Barr virus: another tale on autoimmunity","volume":"24","author":"Danieli","year":"2017","journal-title":"Eur J Neurol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2018.11.001","article-title":"EBV-NMDA double positive encephalitis in an immunocompromised patient","volume":"396","author":"Garre","year":"2019","journal-title":"J Neurol Sci"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2006.05.014","article-title":"Increased intracranial pressure due to chronic active Epstein-Barr virus infection","volume":"35","author":"Dagdemir","year":"2006","journal-title":"Pediatr Neurol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.actatropica.2010.08.007","article-title":"Usefulness of various MRI sequences in the diagnosis of viral encephalitis","volume":"116","author":"Misra","year":"2010","journal-title":"Acta Trop"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.10201","article-title":"Neurological complications of acute and persistent Epstein-Barr virus infection in paediatric patients","volume":"68","author":"Hausler","year":"2002","journal-title":"J Med Virol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1002\/1531-8249(199905)45:5<659::aid-ana16>3.0.co;2-9","article-title":"Epstein-Barr virus meningoencephalitis with a lymphoma-like response in an immunocompetent host","volume":"45","author":"Schellinger","year":"1999","journal-title":"Ann Neurol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2019-231661","article-title":"Intravenous immunoglobulins in an adult case of post-EBV cerebellitis","volume":"13","author":"D\u2019ambrosio","year":"2020","journal-title":"BMJ Case Rep"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1007\/s004310050658","article-title":"Epidemiology of encephalitis in children. A prospective multicentre study","volume":"156","author":"Koskiniemi","year":"1997","journal-title":"Eur J Pediatr"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2017.01867","article-title":"Chronic Active Epstein-Barr Virus Disease","volume":"8","author":"Kimura","year":"2017","journal-title":"Front Immunol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2021.618830\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,25]],"date-time":"2021-02-25T09:22:03Z","timestamp":1614244923000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2021.618830\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,25]]},"references-count":33,"alternative-id":["10.3389\/fimmu.2021.618830"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2021.618830","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,25]]},"article-number":"618830"}}