An Unusual Case of CMV/EBV Ventriculoencephalitis with Evolution to Primary Central Nervous System Lymphoma in HIV-Positive Patient

Abstract

Epstein–Barr virus (EBV) is a well-known cause of different types of malignancies particularly Burkitt's lymphoma, nasopharyngeal carcinoma, Hodgkin's lymphomas, and non-Hodgkin's lymphomas including primary central nervous system lymphoma (PCNSL). A higher tendency of malignant transformation associated with EBV has been noticed in immunocompromised patients, such as human immunodeficiency virus (HIV) infected patients. The rapid and effective immune reconstitution is crucial to prevent PCNSL in HIV-positive patients. We present a clinical case of a young patient diagnosed with HIV infection and medicated with antiretroviral therapy (ART) with poor immunological recovery. After two weeks, he developed ventriculoencephalitis, observed in the cranial magnetic resonance imaging (MRI), caused by cytomegalovirus (CMV) and EBV, both with high serum viral load, rapidly evolving to PCNSL. With this unusual clinical case, the authors want to draw attention to the importance of rapid immunological reconstitution in preventing the progression of EBV infection to PCNSL, as well as encouraging the confirmation of the usefulness of early combination of chemotherapy and antiviral therapy, in order to reach a more effective treatment of this herpesvirus infection and associated malignancies.

Encephalopathy Associated with Severe Cytomegalovirus Infection in an Immunocompetent Young Woman

“…Several mechanisms have been proposed as the cause of simultaneous positive IgM for EBV and CMV. Given that blood CMV DNA and EBV DNA were detected in this case they include, it is considered that there is the possibility of the two mechanisms: (1) EBV and CMV superinfection and (2) reactivation of latent EBV caused by transient suppression of cell-mediated immunity or settings of acute systemic stress such as cytokine storm caused by CMV infection [ 7 – 9 ]. Furthermore, anti-Epstein–Barr virus nuclear antigen (EBNA) IgG was persistently positive from the beginning; thus, we could rule out the possibility of primary infection of EBV ( Table 1 ).…”