EBV-associated CNS Infection in an Immunocompetent Adult: A Case
Report and Literature Review
Gwyn Srifuengfung, MD1, Pichatorn Suppakitjanusant,
MD1, Nattanicha Chaisrimaneepan, MD2
1Department of Neurology, Texas Tech University Health
Sciences Center, Lubbock, TX, USA
2Department of Medicine, Texas Tech University Health
Sciences Center, Lubbock, TX, USA
Corresponding author: Nattanicha Chaisrimaneepan, MD
Department of Internal Medicine, Texas Tech University Health Sciences
Center, Lubbock, TX, USA
3601 4th St, Lubbock, TX 79430
Email: nattanicha.chaisrimaneepan@ttuhsc.edu
Disclosure: All the authors declare no conflict of interest.
Verbal and written consent was obtained from the patient to publish his
case.
Abstract
Epstein-Barr virus (EBV) infections typically manifest with respiratory
symptoms, lymphadenopathy, and, rarely, central nervous system (CNS)
involvement. We report an uncommon case of an immunocompetent
18-year-old male with altered mental status due to EBV-associated CNS
infection. The patient, with a recent history of infectious
mononucleosis, presented with fever and meningeal irritation signs.
Initial investigations revealed leukocytosis, atypical lymphocytes, and
positive heterophile antibodies, but a head CT scan was normal.
Empirical treatment for bacterial meningitis was initiated. Results of
further assessments, including a positive EBV serology, a consistent
cerebrospinal fluid analysis and positive EBV DNA in the CSF led to the
diagnosis of EBV-associated CNS infection-more specifically
meningoencephalitis. Neuroimaging, including MRI, showed no
abnormalities. The patient improved with supportive care and a four-day
course of acyclovir. We discussed the challenges in diagnosing
EBV-associated CNS infection, emphasizing the role of CSF PCR in
confirming the diagnosis. The importance of ruling out other infections
is highlighted, and the heterogeneity in the mechanism of infection is
explored. The case underscores the significance of recognizing an
isolated, active EBV infection in young adults with altered mental
status, especially when more common causes have been excluded.
Keywords: Epstein-Barr virus, CNS infection, aseptic meningitis, altered
mental status, CSF PCR, viral encephalitis.