Infectious mononucleosis is a viral syndrome that is most often caused by Epstein-Barr virus (EBV). A few patients, at the time of the initial infection with EBV, reportedly manifest neurological symptoms, such as meningitis, Guillain-Barré syndrome, and encephalitis. We report a case of infectious myelitis in association with infectious mononucleosis caused by EBV. The patient was a 23-year-old woman who presented with persistent sore throat, fever, and cervical lymphadenopathy. Examination revealed bilateral tonsillar hypertrophy with redness and pus discharge. After making a diagnosis of infectious mononucleosis based on the laboratory data and findings of physical examination, we treated the patient with antibiotics. On the fourth day after the initiation of treatment, the patient showed unilateral motor and sensory paralysis of acute onset. Cervical MRI revealed high signal intensities in the C5 section of the spinal cord. Neurologists at our institution began the patient on pulse therapy with methylprednisolone. After two courses of steroid pulse therapy, the motor and sensory paralysis improved. Cerebrospinal fluid examination revealed a negative test result for EBV-DNA, but the patient was diagnosed as having infectious myelitis caused by EBV from the clinical course.
We examined the relationship between patient factors, tumor factors, inflammation/nutritional factors, inflammation/nutritional compound factors, and overall survival (OS)/disease-free survival (DFS) in 40 patients of oropharyngeal squamous cell carcinoma who had received primary treatment at our institution between November 2014 and July 2019. We selected age, sex, smoking (Brinkman index), drinking habit, presence/absence of double cancer, and body mass index (BMI) as the patient factors; primary subsite, TNM classification (UICC/AJCC, 8th edition), and p16 immunostaining status as the tumor factors, serum levels of albumin, hemoglobin, and peripheral blood lymphocyte count, neutrophil count and platelet count, and serum C-reactive protein (CRP) as inflammation/nutritional factors, and the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), CRP/albumin ratio (CAR), prognostic nutritional index (PNI), modified Glasgow prognostic score (mGPS), and modified controlling nutritional status (mCONUT) as inflammation/nutritional compound factors. The Kaplan-Meier method and log-rank test were used for calculating and comparing the OS/DFS. Multivariate analysis using the Cox proportional-hazards model was conducted using, as explanatory variables, variables that were identified as significant with p<0.05 in the univariate analysis. The OS follow-up period was 2–45 months (median, 15 months), and the 3-year OS was 77.8% (95% CI=0.583–0.889). Factors that had significant influence on the OS were the age, Brinkman index, serum CRP, NLR, PLR, CAR, PNI, and mGPS. The DFS follow-up period was 1–45 months (median, 12 months) and the 3-year DFS was 54.7% (95% CI=0.296–0.670). Factors that were identified as having a significant influence on the DFS were the Brinkman index, platelet count, PLR, and mGPS. However, multivariate analysis did not identify the Brinkman index as an independent poor prognostic factor for either the OS or the DFS. However, because it is suspected that the Brinkman index is a significant prognostic factor, it is suggested that a better prognostic classification may be obtained by combining all these factors. We suggest that biomarkers derived from routine laboratory tests can contribute to identifying the risk of recurrence and selection of appropriate treatment in patients with oropharyngeal carcinoma.
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