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The effects of specific antibodies in chronic echovirus type 5 (echo 5) encephalitis were investigated in a patient with x-linked hypogammaglobulinemia. Virus was detected in cerebrospinal fluid (CSF) and blood despite treatment with commercial human gammaglobulin that contained low titers of antibodies to echo 5 (0.6 x 10(4) units per injection). Virus disappeared from blood and CSF when plasma containing high concentrations of antibodies (total dose, 1--4 x 10(4) units/kg) was administered intravenously. Maximal inhibition of virus was achieved in culture and in the patient's CSF when the titer of antibody to echo 5 in CSF was greater than or equal to 16 units/ml. Although the patient died, hyperimmune plasma improved the neurologic status and eliminated detectable virus from the blood and CSF.