Plasmapheresis improves outcome in postinfectious cerebellitis induced by Epstein–Barr virus

Abstract

Postinfectious cerebellitis (PIC) is a rare complication of Epstein–Barr virus (EBV) infection. Whereas its course is usually regarded as self-limited, it can be prolonged and produce considerable residual disability. We report two adults with persistent PIC after EBV infection who demonstrated complete and rapid recovery with a course of plasmapheresis (total plasma exchange [TPE]). ### Case 1. A 20-year-old woman (Case 15 in reference 1) developed fever and myalgia, followed 2 weeks later by onset over 3 days of slurred speech, gait instability, and difficulty judging distances. Examination revealed hypermetric saccadic eye movements, cerebellar dysarthria, dysmetria, dysdiadochokinesis, and ataxic gait. She had flattened affect, decreased verbal output and phonemic fluency, perseveration, and poor visual-spatial planning. Results of strength, reflex, and sensory testing were normal. Gadolinium-enhanced brain MRI and EEG were normal. CSF revealed three lymphocytes, normal protein, and glucose. Heterophile antibody was positive; serum EBV titer was 1:896; EBV …