CMV encephalitis in an immune-competent patient

Area of Science:

• Neurology
• Infectious Diseases
• Virology

Background:

• Cytomegalovirus (CMV) is a common virus that typically causes asymptomatic infection in healthy individuals.
• CMV infection can lead to severe disease, including encephalitis, particularly in immunocompromised patients.
• This case explores CMV encephalitis in a patient without typical risk factors like HIV or immunosuppressive therapy.

Observation:

• A 61-year-old woman presented with atypical chest pain, progressing to lethargy, confusion, and global dysphasia.
• Magnetic Resonance Imaging (MRI) suggested encephalitis, and cerebrospinal fluid analysis confirmed Cytomegalovirus (CMV) PCR positivity.
• The patient had a history of poorly controlled diabetes mellitus and a recent intensive care unit (ICU) admission.

Findings:

• The patient received intravenous ganciclovir followed by oral valganciclovir, leading to a gradual recovery.
• Despite being HIV-negative and not on immunosuppressive therapy, the patient developed CMV encephalitis.
• Poorly controlled diabetes mellitus and prior ICU admission were identified as potential risk factors for CMV reactivation and subsequent encephalitis.

Implications:

• CMV encephalitis should be considered in the differential diagnosis of new-onset neurological deficits, even in seemingly immunocompetent patients.
• Underlying conditions such as poorly controlled diabetes mellitus may contribute to an immunocompromised state, increasing susceptibility to opportunistic infections like CMV.
• Previous ICU admission may represent a risk factor for viral reactivation, including CMV, necessitating further investigation.