Daniel S. Chertow, MD, MPH; Avindra Nath, MD; Anthony F. Suffredini, MD; Robert L. Danner, MD; Daniel S. Reich, MD, PhD; Rachel J. Bishop, MD; Richard W. Childs, MD; Andrew E. Arai, MD; Tara N. Palmore, MD; H. Clifford Lane, MD; Anthony S. Fauci, MD; Richard T. Davey, MD
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Acknowledgment: The successful care of this patient is attributed to the efforts of the multidisciplinary team at the National Institutes of Health Clinical Center. This team comprised volunteers and included Special Clinical Studies Unit and critical care nurses, respiratory therapists, a radiology technician, laboratory technicians, a pharmacist, a dietitian, hospital epidemiologists, critical care and infectious diseases physicians, and WatSans from diverse backgrounds. To these individuals, the authors express their gratitude.
Grant Support: The Intramural Research Program of National Institute of Allergy and Infectious Diseases, National Institutes of Health, supported this work.
Disclosures: Dr. Reich reports grants from Vertex Pharmaceuticals outside the submitted work. Authors not named here have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-3066.
This article was published at www.annals.org on 5 April 2016.
Sequential multiorgan failure in a patient with Ebola virus disease despite adequate blood pressure control.
aPPT = activated partial thromboplastin; AST = aspartate aminotransferase; CR = creatinine; MAP = mean arterial blood pressure; RT- PCR = reverse transcriptase polymerase chain reaction; WBC = white blood cell. A. Clinical course: Text boxes show approximate onset and resolution of clinical findings, and the line graph shows cycle threshold value that Ebola virus glycoprotein RNA was detected by quantitative RT-PCR in serum. B. Select vital signs: Maximum daily temperature (red), maximum daily heart rate (yellow), and minimum daily MAP (blue). C. Complete blood count: Hemoglobin level (red), total leukocyte (WBC) count (yellow), and platelet count (blue). D. Serum chemistries: AST level (purple), total bilirubin level (blue), Cr kinase level (red), and serum Cr level (yellow). E. Coagulation: aPPT level (blue) and d-dimer level (red).
Brain MRI after recovery from Ebola meningoencephalitis.
Initial MRI was performed on day 33. MRI = magnetic resonance imaging. A. T2-weighted fluid-attenuated inversion recovery image showing multiple punctate high-signal intensity lesions in the corpus callosum. B and C. Some of the corpus callosum lesions (B), as well as a lesion on the margin of the fourth ventricle (C), showed restriction of diffusion, compatible with microvascular occlusion and ischemia. D. A lesion in the right lateral column of the thoracic spinal cord. E to H. Repeated MRI showing resolution of most of the previous lesions.
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Daniel S. Chertow, Avindra Nath, Anthony F. Suffredini, Robert L. Danner, Daniel S. Reich, Rachel J. Bishop, et al. Severe Meningoencephalitis in a Case of Ebola Virus Disease: A Case Report. Ann Intern Med. 2016;165:301–304. doi: 10.7326/M15-3066
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Published: Ann Intern Med. 2016;165(4):301-304.
Published at www.annals.org on 5 April 2016
CNS Infections, Infectious Disease, Neurology.
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