Chronic hepatitis B infection presenting with chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids CLIPPERS: a case reportReport as inadecuate




Chronic hepatitis B infection presenting with chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids CLIPPERS: a case report - Download this document for free, or read online. Document in PDF available to download.

Journal of Medical Case Reports

, 9:266

First Online: 19 November 2015Received: 11 May 2015Accepted: 26 October 2015DOI: 10.1186-s13256-015-0750-1

Cite this article as: Weng, CF., Chan, DC., Chen, YF. et al. J Med Case Reports 2015 9: 266. doi:10.1186-s13256-015-0750-1

Abstract

IntroductionChronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids is a brainstem disorder characterized by perivascular pathologic reaction with lymphocyte infiltration and leading to diplopia, facial palsy, dysarthria, and gait ataxia. It was thought to be an autoimmune disorder without distinct pathogenesis. Chronic hepatitis B virus infection has been proposed in correlation with autoimmune diseases, including central nervous system demyelinating disease. Patients with chronic hepatitis B infection may develop the syndrome of chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids.

Case presentationA 34-year-old Taiwanese man who had been a hepatitis B virus carrier for a decade presented to our emergency room. He had influenza symptoms and progressive symptoms of left hemifacial numbness, double vision, and an unsteady gait of 2 days’ duration. Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids was diagnosed, with increased hepatitis B viral load at the same time. He had no past history of similar neurologic deficits, and his liver function tests had been within normal limits before this episode. After corticosteroid and entecavir treatments, his neurological deficits and neuroimaging anomalies improved and his serum hepatitis B virus DNA viral load normalized.

ConclusionsHepatitis B virus infection may induce central nervous system autoimmune reactions, including chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. In such cases, concomitant administration of corticosteroids and antiviral agent was helpful. We suggest further investigations in patients with regulatory T cell dysfunction, which may assist in clarifying a loss of immune tolerance in patients with such disorders.

KeywordsAutoimmunity CLIPPERS Demyelinating disease Encephalomyelitis Hepatitis B Regulatory T cell AbbreviationsASTaspartate aminotransferase

CLIPPERSchronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids

CNScentral nervous system

CSFcerebrospinal fluid

HBehepatitis B e

HBVhepatitis B virus

Igimmunoglobulin

MRImagnetic resonance imaging

MSmultiple sclerosis

Tregregulatory T cell

Ching-Fu Weng and Ding-Cheng Chan contributed equally to this work.

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Author: Ching-Fu Weng - Ding-Cheng Chan - Ya-Fang Chen - Fei-Chih Liu - Horng-Huei Liou

Source: https://link.springer.com/







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