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Updated: Sep 19, 2025
Use of In vivo Imaging to Monitor the Progression of Experimental Mouse Cytomegalovirus Infection in Neonates
Published on: July 6, 2013
Cytomegalovirus meningoencephalitis in an immunocompetent host with evolution of cystic encephalomalacia
Derryl J Miller1, Jade Davis2, Whitney Gervelis3
1Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.
Abstract:
A previously healthy 2-month-old male presented with fever and seizures. Cerebrospinal fluid (CSF) studies, head computed tomography (CT), and brain magnetic resonance imaging (MRI) studies were unremarkable on admission. After a clinical decline on the second day admission due to cerebral edema a repeat head CT showed loss of gray-white matter differentiation indicative of global anoxic injury. A repeat brain MRI on day 5 revealed diffuse restricted diffusion globally, acute infarction of the right posterior inferior cerebellar artery territory, and left frontoparietal leptomeningitis versus cortical laminar necrosis. A repeat LP was done on day 5 and showed a total nucleated cell count of 42 cells/mm^3 with 39% lymphocytes and 61% monocytes, glucose 52 mg/dL. He made steady clinical improvement with supportive care. CMV was detected on the repeat CSF sample using PCR on day 11 and he was started on ganciclovir for CMV meningoencephalitis. CMV should be considered as an etiology for viral meningoencephalitis even in immunocompetent patients. Our case also shows the classic imaging evolution of CMV meningoencephalitis.
Insights
Cytomegalovirus (CMV) meningoencephalitis can affect immunocompetent infants, presenting with fever and seizures. Early diagnosis and ganciclovir treatment are crucial for recovery, as shown by this case study.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neuroradiology
Background:
- Cytomegalovirus (CMV) is a common pathogen, but meningoencephalitis in immunocompetent infants is rare.
- Early presentation of fever and seizures in infants necessitates prompt etiological investigation.
Observation:
- A previously healthy 2-month-old male presented with fever and seizures.
- Initial CSF, CT, and MRI were unremarkable, but clinical decline led to repeat imaging.
- Repeat MRI revealed global anoxic injury, cerebellar infarction, and leptomeningitis.
Findings:
- Cytomegalovirus (CMV) was detected via PCR in cerebrospinal fluid (CSF) on day 11.
- The patient was diagnosed with CMV meningoencephalitis and treated with ganciclovir.
- Imaging demonstrated characteristic evolution of CMV meningoencephalitis.
Implications:
- CMV should be considered in the differential diagnosis of viral meningoencephalitis in immunocompetent infants.
- This case highlights the importance of serial neuroimaging in diagnosing evolving neurological conditions.
- Prompt diagnosis and treatment of CMV meningoencephalitis can lead to favorable clinical outcomes.
