# A Case Report of a Rapidly Progressive Epstein-Barr Virus Encephalitis Infection in an Adult With HIV on Highly Active Antiretroviral Therapy

## TL;DR

This case report describes a rare instance of Epstein-Barr virus encephalitis in an HIV-positive adult on antiretroviral therapy who made a full recovery with antiviral treatment.

## Contribution

The novelty lies in presenting a rare case of EBV encephalitis in an HIV-positive adult on HAART without prior neurocognitive symptoms.

## Key findings

- EBV encephalitis occurred in an HIV-positive adult on HAART without pre-existing neurocognitive symptoms.
- The patient fully recovered after treatment with IV acyclovir and oral valacyclovir.
- CSF analysis confirmed EBV DNA via PCR, with no other infections detected.

## Abstract

Epstein-Barr virus (EBV) encephalitis is a rare complication of EBV infection, with most cases described in children. Although some cases of EBV encephalitis have been reported in adults, they have occurred in the presence of other central nervous system infections, superimposed on an underlying neurocognitive disorder, or in immunocompromised states. We present herein a rare case of rapidly progressive EBV encephalitis in an adult male with HIV infection on highly active antiretroviral therapy (HAART) with no pre-existing neurocognitive symptoms. A 52-year-old African American man with HIV infection on HAART presented with acute altered mental status and weakness. On admission, he had normal muscle tone and reflexes, with no signs of meningism. Head CT without contrast showed no acute intracranial pathology. Blood and urine cultures were negative. CSF analysis was suggestive of a viral infection. Viral studies were positive only for EBV DNA by PCR in CSF. The patient received IV acyclovir for two weeks, followed by four weeks of oral valacyclovir with full recovery. Clinicians should consider a diagnosis of EBV encephalitis in HIV-positive patients on HAART who present with acute altered mental status. Treatment with antiviral therapy should be considered in patients with EBV encephalitis.