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Atypical presentation and diagnosis of AIDS-related CMV encephalitis
Erick Kawegere1,2, Tamara Goldberg2,3
1Icahn School of Medicine at Mount Sinai, New York, NY, USA e.kawegere@hotmail.com.
Abstract:
We report a case of man in his 40s with a medical history of post-traumatic stress disorder who presented to the emergency department with altered mental status, ataxia, headache and dizziness a few hours after snorting amphetamines and mushrooms. Twenty-four hours after presentation, while no longer abusing amphetamines or mushrooms, he remained ataxic and dizzy. A CT scan of the head showed periventricular hypodensities. MRI of the brain revealed extensive confluent T2 hyperintense signal throughout the cerebral white matter, brainstem and cerebellar white matter. Given these findings and persistent ataxia, lumbar puncture was performed, and cerebrospinal fluid (CSF) meningoencephalitis panel was positive for cytomegalovirus (CMV), prompting a diagnosis of CMV encephalitis. Since CMV almost always occurs in the setting of immunocompromise, the patient was screened for HIV and found to be positive with a CD4 count of 22. He was treated with ganciclovir 5 mg/kg/dose intravenously every 12 hours, with resolution of all symptoms.
Insights
A man with PTSD developed cytomegalovirus (CMV) encephalitis after drug use. Prompt treatment with ganciclovir led to symptom resolution, highlighting the importance of early diagnosis in immunocompromised patients.
Area of Science:
- Neurology
- Infectious Diseases
- Toxicology
Background:
- Cytomegalovirus (CMV) encephalitis typically affects immunocompromised individuals.
- Drug abuse can precipitate opportunistic infections in susceptible populations.
Observation:
- A middle-aged male with a history of PTSD presented with altered mental status, ataxia, headache, and dizziness post-amphetamine and mushroom use.
- Neurological examination revealed persistent ataxia and dizziness despite cessation of drug use.
- Brain imaging (CT and MRI) demonstrated white matter abnormalities in the cerebrum, brainstem, and cerebellum.
Findings:
- Cerebrospinal fluid analysis confirmed Cytomegalovirus (CMV) infection, leading to a diagnosis of CMV encephalitis.
- Human Immunodeficiency Virus (HIV) screening revealed a CD4 count of 22, indicating severe immunocompromise.
- Intravenous ganciclovir treatment resulted in complete symptom resolution.
Implications:
- This case underscores the potential for drug use to trigger opportunistic infections like CMV encephalitis in undiagnosed HIV-positive individuals.
- Early diagnosis and treatment of CMV encephalitis are crucial for favorable outcomes, even in complex clinical presentations.
- Highlights the need for comprehensive screening in patients presenting with neurological symptoms after substance abuse, particularly for underlying immunocompromise.
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