Cytomegalovirus Ventriculoencephaltis Post-Temozolomide Use For Glioblastoma Multiforme

We report a case of a male in his 60s with a past medical history of glioblastoma status post chemoradiotherapy and surgical resection. He had completed neoadjuvant temozolomide and was 26 days post-chemotherapy on presentation. He presented with fever, weakness, and confusion. Further evaluation revealed cytomegalovirus (CMV) ventriculoencephaltis. He was started on valganciclovir, but his hospital course was complicated by a pulmonary embolism. Repeat imaging showed tumor progression, and he was a poor surgical candidate. This case highlights the complexities of managing patients with opportunistic infections post-chemotherapy. It adds to the growing literature of disseminated, invasive, and often lethal CMV infections in non-HIV patients post-use of temozolomide. We urge the need for vigilant monitoring and consideration of prophylactic measures in individuals deemed at risk for invasive CMV.