Cytomegalovirus meningitis in a patient with relapsed acute myeloid leukemia

Area of Science:

• Neurology
• Infectious Diseases
• Hematology

Background:

• Cytomegalovirus meningitis/encephalitis is a severe complication post-hematopoietic stem cell transplantation.
• Cases are rarely reported before transplantation, primarily in lymphoid malignancies.
• No prior reports existed for patients with myeloid malignancies.

Observation:

• A 36-year-old male with relapsed acute myeloid leukemia developed prolonged grade 4 lymphopenia after salvage chemotherapy.
• The patient presented with pyrexia, headache, nausea, and vomiting, with normal brain imaging.
• Symptoms persisted despite antimicrobial treatment, with positive CMV-DNA in CSF and CMV pp65 antigenemia.

Findings:

• Cytomegalovirus meningitis was diagnosed based on clinical presentation and laboratory findings.
• Ganciclovir treatment resulted in rapid improvement of the patient's headache and fever.
• This case highlights CMV meningitis as a potential diagnosis in heavily treated AML patients with CNS symptoms.

Implications:

• Cytomegalovirus meningitis should be considered in the differential diagnosis of central nervous system symptoms in acute myeloid leukemia patients, especially those heavily treated.
• This case expands the understanding of CMV meningitis presentation in the pre-transplant setting for myeloid malignancies.
• Prompt diagnosis and antiviral therapy are crucial for managing this potentially fatal complication.