Vasculitic Leukoencephalopathy Secondary to Epstein-Barr Virus: A Diagnostic Challenge Due to an Atypical Presentation — A Case Report
Che Ake- Enrique Antonio1, Euan Cervera-Víctor Manuel1, Cabrera Tamayo-Heidy Beatriz1, Domínguez González – Edward Darielle1*
1Programa de residencia medica servicio de Medicina Interna del Hospital de Especialidades de Campeche “Dr. Javier Buenfil Osorio” Av. José López Portillo Héctor Pérez Martínez (By Patricio Trueba de Regil) 24050, Campeche. México.
*Corresponding Author: Domínguez González – Edward Darielle, Programa de residencia medica servicio de Medicina Interna del Hospital de Especialidades de Campeche “Dr. Javier Buenfil Osorio” Av. José López Portillo Héctor Pérez Martínez (By Patricio Trueba de Regil) 24050, Campeche. México. ORCID: https://orcid.org/0009 -0000 -9462 -134X.
DOI: https://doi.org/10.58624/SVOANE.2026.07.011
Received: March 29, 2026
Published: April 20, 2026
Citation: Enrique Antonio CA, Víctor Manuel EC, Heidy Beatriz CT, Edward Darielle DG. Vasculitic Leukoencephalopathy Secondary to Epstein-Barr Virus: A Diagnostic Challenge Due to an Atypical Presentation — A Case Report. SVOA Neurology 2026, 7:2, 67-73. doi.org/10.58624/SVOANE.2026.07.011
Abstract
Vasculitis that clinically and pathologically affects the central nervous system (CNS) alone is defined as primary or isolated CNS vasculitis. Although rare, it is a diagnosis that should be considered by internists and neurologists in patients presenting with progressive neurological signs and symptoms of uncertain origin. There is no specific imaging or laboratory pattern that guides the diagnosis, and aside from biopsy, magnetic resonance imaging (MRI) is the only study that can substantially contribute to a definitive diagnosis. We report the case of a 20 -year -old man from Campeche diagnosed with small -vessel CNS vasculitis who initially presented with cognitive impairment. Polymerase chain reaction (PCR) testing of cerebrospinal fluid (CSF) was positive for Epstein -Barr virus. Two brain biopsies were performed, both revealing lymphocytic vasculitis with perivascular necrosis and foamy macrophages associated with secondary demyelination, Chronic vascular injury may manifest as cognitive decline; however, its occurrence as an initial presentation is extremely rare. This case represents a clear example of the diagnostic challenge posed by vasculitis, particularly when neurological manifestations are the sole clinical findings, and underscores the importance of biopsy in the diagnostic approach.
Keywords: Vasculitis, infection, Epstein-Barr, Cognitive impairment, Central Nervous System
