# Cytotoxic Lesions of the Corpus Callosum (CLOCCs) in a Patient with Epstein–Barr Infection: A Case Report and Literature Review

## TL;DR

A 15-year-old girl with Epstein–Barr virus developed severe CLOCCs, showing rapid clinical improvement despite MRI changes.

## Contribution

This case report highlights EBV as a potential cause of severe CLOCCs and emphasizes the importance of MRI in diagnosis.

## Key findings

- The patient showed rapid clinical improvement despite MRI evidence of CLOCCs.
- MRI changes in the corpus callosum gradually regressed over months.
- Clinical abnormalities can precede radiological changes in CLOCCs.

## Abstract

Background: Cytotoxic lesions of the corpus callosum (CLOCCs) are a rare disorder of various etiologies referred to as transient lesions of the splenium of the corpus callosum, with a usually mild clinical course. Epstein–Barr virus (EBV) is one of the factors potentially responsible for triggering this abnormality. Results: The authors present the case of a 15-year-old girl, so far without any health burden, who suffered from severe CLOCCs with the etiology of EBV. The patient was admitted to hospital because of hepatosplenomegaly and hypertransaminasemia. Her condition rapidly deteriorated—she had seizures with respiratory failure, requiring treatment in the PICU. The first MRI (magnetic resonance imaging) scan showed changes in the hippocampus, and, in the early control, changes like those of CLOCCs; in follow-up studies (one and three months after the onset of respiratory failure), a gradual incomplete regression of the changes in the corpus callosum was seen. Her clinical condition improved quickly, with no seizures during the follow-up and no signs of focal CNS deficits. Cases of CLOCCs are reported as a secondary syndrome connected with many disease entities (e.g., toxic, infectious, and metabolic). The clinical presentation ranges from asymptomatic to severe cases demanding intensive treatment. The diagnosis is determined via an MRI examination. Conclusions: The general prognosis for CLOCCs is good, though the normalization of a brain MRI can take several months. As the only method of showing CLOCCs, MRI is the imaging gold standard. Still, clinical abnormalities often precede radiological changes, as was the case with the reported patient.