# Severe cytomegalovirus encephalitis in an immunocompetent man: a case report

## TL;DR

A 46-year-old immunocompetent man developed severe CMV encephalitis, diagnosed through MRI and PCR, and recovered with antiviral treatment.

## Contribution

Highlights the rare but severe presentation of CMV encephalitis in an immunocompetent individual and the role of imaging in diagnosis.

## Key findings

- CMV encephalitis can occur in immunocompetent individuals with severe neurological symptoms.
- MRI and PCR testing were crucial for diagnosing CMV in this case.
- Prompt antiviral treatment led to a favorable clinical outcome.

## Abstract

Cytomegalovirus (CMV) is a viral infection that is generally considered benign in immunocompetent patients; however, it can be life-threatening in immunocompromised patients. We present the case of a 46-year-old patient with severe primary CMV encephalitis. The patient presented to the hospital emergency department with impaired alertness and speech. A brain scan and initial lumbar puncture (LP) were normal. However, the patient’s state of consciousness deteriorated rapidly with the onset of seizures, prompting a brain MRI scan, which revealed lesions suggestive of encephalitis. Polymerase Chain Reaction (PCR) detection of cytomegalovirus was confirmed on a second lumbar puncture. Following the confirmation of the diagnosis, the patient was commenced on appropriate antiviral treatment, which resulted in a favourable outcome. Our aim is to report on the clinical manifestations and the contribution of imaging to the diagnosis of CMV encephalitis in immunocompetent persons.