Japanese-B Viral Encephalitis with a Biphasic Illness Pattern and Recovery after Intravenous Immunoglobulin Therapy

Byung-Chan Lee; Ji Ye Jeon; Hye-Jin Moon; Jeong Geun Lim; Yong Won Cho

doi:10.14253/kjcn.2014.16.1.35

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Lee, Jeon, Moon, Lim, and Cho: Japanese-B Viral Encephalitis with a Biphasic Illness Pattern and Recovery after Intravenous Immunoglobulin Therapy

Case Report

Korean J Community Nutr 2014;16(1):35-38.

Published online: 18 January 2014

DOI: https://doi.org/10.14253/kjcn.2014.16.1.35

Japanese-B Viral Encephalitis with a Biphasic Illness Pattern and Recovery after Intravenous Immunoglobulin Therapy

Byung-Chan Lee, Ji Ye Jeon, Hye-Jin Moon, Jeong Geun Lim, Yong Won Cho

Department of Neurology, Keimyung University School of Medicine, Daegu, Korea

Address for correspondence; Hye-Jin Moon Department of Neurology, Dong San Medical Center, Keimyung University, Dalseong-ro 56, Daegu 700-712, Korea Tel: +82-53-250-7831 Fax: +82-53-250-7840 E-mail: moonhyejin21@gmail.com

Received 13 November 2013 Revised 11 March 2014 Accepted 9 June 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Japanese-B viral encephalitis (JE) usually has a monophasic illness pattern. A 45-year-old woman in an altered mentality had improved over 1 month. About 1 week after the initial improvement, the patient became comatose with aggravated EEG and MRI findings. Assays of cerebrospinal fluid and serum were positive for the IgM antibody to Japanese-B virus. After intravenous immunoglobulin (IVIG) infusion, the patient recovered. We report a patient with JE who showed a biphasic illness pattern and recovered after IVIG therapy. (Korean J Clin Neurophysiol 2014;16:35-38)

Keywords: Japanese-B viral encephalitis, IVIG, Biphasic illness

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Figure 1.

Brain magnetic resonance images on hospital day 2. Fluid attenuated inversion recovery (FLAIR) images show high signal intensities of bilateral hippocampus (arrow).

Figure 2.

Electroencephalographies on hospital days 7, 46, and 53. On hospital day 7 (A), EEG showed frontal intermittent rhythmic delta activity (FIRDA). On hospital day 46 (B), the patient was comatose, and EEG showed continuous generalized delta activity. After intravenous immune globulin (IVIG) therapy, on hospital day 53 (C), EEG was normalized.

Figure 3.

Follow up brain magnetic resonance images on hospital day 39. Follow up fluid attenuated inversion recovery (FLAIR) images showed increased high signal intensity lesions of bilateral hippocampus (arrow) and additional high signal intensity lesions of bilateral medial thalamus, basal ganglia, periventricular white matter, and juxtacortical white matter (arrow head).

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