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Cytomegalovirus Meningoencephalitis in a Critically Ill Elderly Female: A Case Report
Anna Anjelica R Sanchez1,2, Archimedes Apa-Ap3, Jennifer Chua3
1Department of Internal Medicine, Section of Neurology, Cardinal Santos Medical Center, San Juan City, PHL.
Abstract:
Cytomegalovirus (CMV) disease is usually a mild and self-limiting disease in immunocompetent patients. Recent evidence shows that CMV infection may also develop in the setting of critical illness, burn and sepsis and is usually associated with increased mortality rate and prolonged ICU stay. This paper describes an 83-year-old female who was initially admitted as a case of community-acquired pneumonia-high risk but remained febrile with paucity of verbal output despite correction of pneumonia and other electrolyte derangements. MRI showed the presence of peculiar-appearing signal abnormalities in the interhemispheric region and the anterior frontal convexities which were suspected to represent secondarily infected fluid collections. On lumbar tap, viral cerebrospinal fluid (CSF) panel showed a positive result for CMV infection. The patient was then given ganciclovir for 14 days followed by valganciclovir for three months. The most notable improvement was noted with the lysis of fever several days after starting anti-viral treatment. Verbal output remained limited, yet, on repeat tap after completion of treatment, CMV viral panel is now negative.
Insights
Cytomegalovirus (CMV) infection can occur in critically ill patients, leading to prolonged ICU stays. This case highlights successful treatment of CMV encephalitis in an elderly patient with ganciclovir and valganciclovir.
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Cytomegalovirus (CMV) is typically mild in immunocompetent individuals.
- CMV infection is increasingly recognized in critical illness, associated with higher mortality and longer ICU stays.
- This includes conditions like sepsis and severe pneumonia.
Observation:
- An 83-year-old female with community-acquired pneumonia presented with persistent fever and reduced verbal output.
- Cerebrospinal fluid analysis revealed Cytomegalovirus (CMV) infection.
- MRI indicated signal abnormalities suggestive of infected fluid collections in the brain.
Findings:
- The patient received a 14-day course of ganciclovir followed by three months of valganciclovir.
- Antiviral treatment led to fever resolution.
- Post-treatment cerebrospinal fluid analysis confirmed the eradication of CMV.
Implications:
- This case demonstrates the successful management of Cytomegalovirus (CMV) central nervous system infection in an elderly critical care patient.
- Early diagnosis and prompt antiviral therapy are crucial for favorable outcomes.
- Highlights the importance of considering opportunistic infections like CMV in complex critical illness presentations.
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