Cytomegalovirus Meningoencephalitis in a Critically Ill Elderly Female: A Case Report

Abstract

Cytomegalovirus (CMV) disease is usually a mild and self-limiting disease in immunocompetent patients. Recent evidence shows that CMV infection may also develop in the setting of critical illness, burn and sepsis and is usually associated with increased mortality rate and prolonged ICU stay. This paper describes an 83-year-old female who was initially admitted as a case of community-acquired pneumonia-high risk but remained febrile with paucity of verbal output despite correction of pneumonia and other electrolyte derangements. MRI showed the presence of peculiar-appearing signal abnormalities in the interhemispheric region and the anterior frontal convexities which were suspected to represent secondarily infected fluid collections. On lumbar tap, viral cerebrospinal fluid (CSF) panel showed a positive result for CMV infection. The patient was then given ganciclovir for 14 days followed by valganciclovir for three months. The most notable improvement was noted with the lysis of fever several days after starting anti-viral treatment. Verbal output remained limited, yet, on repeat tap after completion of treatment, CMV viral panel is now negative.

Keywords: cmv encephalitis; critically ill elderly patients; cytomegalovirus (cmv); immunocompetent adult; viral meningoencephalitis.

Figure 1. Electroencephalogram on the 22nd hospital day showing mild generalized slowing of background activity.

Figure 2. Cranial MRI done on the 22nd hospital day showing very peculiar-appearing signal abnormalities demonstrating restricted diffusion involving the interhemispheric region and the anterior frontal convexities of uncertain etiology, but are suspected to represent secondarily infected fluid collections.