Severe cytomegalovirus encephalitis in an immunocompetent healthy young woman: A case report

Abstract

Cytomegalovirus (CMV) causes a mild illness in immunocompetent patients. Conversely, it can be life-threatening in immunocompromised or critically ill patients. We present a 48-year-old immunocompetent woman presenting primary severe CMV encephalitis. She presented with a headache, fever, and drowsiness. She did not respond to empirical treatment. Her level of consciousness deteriorated, she was put on mechanical ventilation on day two. Bacterial culture, herpes simplex virus, and tuberculosis were negative in cerebrospinal fluid (CSF). After three weeks, the patient was transferred to our center due to financial matters. Brain magnetic resonance imaging (MRI) showed diffuse hydrocephalus, periventricular T2 hyperintensity, patchy basal ganglia, and diffuse leptomeningeal enhancement. CMV polymerase chain reaction (PCR) was positive in cerebrospinal fluid (CSF) specimen. Ganciclovir (5 mg/kg/IV q12h) was initiated. Subsequently, a brain shunt was inserted. Her level of consciousness raised, she was weaned from the ventilator. She was discharged after 52 days in a bedridden state, quadriplegic, and only able to speak words with a minor swallowing problem. She remained in the same condition for one year. She was expired one year later due to aspiration pneumonia after four weeks of hospitalization. Early diagnosis and treatment of severe CMV encephalitis are crucial to prevent neurological sequelae.

Severe Cytomegalovirus Encephalomyelitis and Polyradiculitis in the Immunocompetent: An Unusual Case of Critical Illness

“…3 On the other hand, CMV-related neurologic infection in immunocompetent patients is very rare: very few cases have been reported in the literature. [4][5][6] In a report of 676 patients with CMV encephalitis, 85% of the patients had HIV infection, 12% had other immunosuppression aetiologies, and only 3% were otherwise healthy. 7 Our patient was immunocompetent, tested negative for HIV on multiple occasions during her hospital stay and was not on immunosuppressive medications.…”

Host-microbe interactions at the blood-brain barrier through the lens of induced pluripotent stem cell-derived brain-like endothelial cells

“…Infectious meningoencephalitis/meningitis can be caused by a number of fungal, viral, or bacterial pathogens, with viruses and bacteria being the most common culprits ( 1 – 3 ). Known viral agents that cause meningoencephalitis include herpes simplex virus ( 4 , 5 ), human herpesviruses 6 and 7 ( 6 , 7 ), enteroviruses ( 8 ), Japanese encephalitis virus ( 9 , 10 ), West Nile virus ( 11 , 12 ), cytomegalovirus ( 13 , 14 ), varicella zoster virus ( 15 , 16 ), Epstein-Barr virus ( 17 , 18 ), human immunodeficiency virus ( 19 , 20 ), and rabies virus ( 21 – 23 ). Bacteria such as Escherichia coli K1 ( 24 ), Mycobacterium tuberculosis ( 25 ), Listeria monocytogenes ( 26 ), Streptococcus pneumoniae ( 27 ), Haemophilus influenzae type b ( 28 ), Group B Streptococcus (GBS) ( 29 , 30 ), and Neisseria meningitidis (Nm) ( 31 ) can cause bacterial meningitis in children and adults ( 3 ).…”

Cytomegalovirus colitis in immunocompetent hosts: A case report and literature review

“…Known immune deficiencies associated with serious CMV diseases include disorders in all or parts of the immune system after transplantation, immunosuppressive therapy, and immunosuppressive diseases such as AIDS. Common end organ disorders caused by CMV in immunocompromised patients include hepatitis which can lead to fulminant liver failure, retinitis especially in HIV‐positive patients, colitis and esophagitis as the first and second most common gastrointestinal tract manifestation of CMV, pneumonitis, especially in hematopoietic stem cell transplant recipients, rarely transverse myelitis, and even encephalitis with poor prognosis 8–14 …”

“…Common end organ disorders caused by CMV in immunocompromised patients include hepatitis which can lead to fulminant liver failure, retinitis especially in HIV‐positive patients, colitis and esophagitis as the first and second most common gastrointestinal tract manifestation of CMV, pneumonitis, especially in hematopoietic stem cell transplant recipients, rarely transverse myelitis, and even encephalitis with poor prognosis. 8 , 9 , 10 , 11 , 12 , 13 , 14 …”

“…Common end organ disorders caused by CMV in immunocompromised patients include hepatitis which can lead to fulminant liver failure, retinitis especially in HIVpositive patients, colitis and esophagitis as the first and second most common gastrointestinal tract manifestation of CMV, pneumonitis, especially in hematopoietic stem cell transplant recipients, rarely transverse myelitis, and even encephalitis with poor prognosis. [8][9][10][11][12][13][14] CMV colitis usually occurs in immunocompromised patients and is prevalent from 21% to 34% worldwide. The symptoms of CMV colitis are very similar to inflammatory bowel disease (IBD) colitis exacerbation.…”