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Atypical presentation and diagnosis of AIDS-related CMV encephalitis
  1. Erick Kawegere1,2 and
  2. Tamara Goldberg2,3
  1. 1Icahn School of Medicine at Mount Sinai, New York, NY, USA
  2. 2Department of Medicine, Mount Sinai Morningside, Mount Sinai West, New York, NY, USA
  3. 3Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  1. Correspondence to Dr Erick Kawegere; e.kawegere{at}hotmail.com

Abstract

We report a case of man in his 40s with a medical history of post-traumatic stress disorder who presented to the emergency department with altered mental status, ataxia, headache and dizziness a few hours after snorting amphetamines and mushrooms. Twenty-four hours after presentation, while no longer abusing amphetamines or mushrooms, he remained ataxic and dizzy. A CT scan of the head showed periventricular hypodensities. MRI of the brain revealed extensive confluent T2 hyperintense signal throughout the cerebral white matter, brainstem and cerebellar white matter. Given these findings and persistent ataxia, lumbar puncture was performed, and cerebrospinal fluid (CSF) meningoencephalitis panel was positive for cytomegalovirus (CMV), prompting a diagnosis of CMV encephalitis. Since CMV almost always occurs in the setting of immunocompromise, the patient was screened for HIV and found to be positive with a CD4 count of 22. He was treated with ganciclovir 5 mg/kg/dose intravenously every 12 hours, with resolution of all symptoms.

  • Brain stem / cerebellum
  • Drugs: CNS (not psychiatric)
  • Infection (neurology)
  • Movement disorders (other than Parkinsons)

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Footnotes

  • Twitter @erickleftie, @taminatorMD

  • Contributors EK first saw the patient during his Infectious Disease Consult Rotation, he then followed him during the course of his treatment and follow-up. The manuscript was prepared by EK, and with valuable and intellectual inputs from TG, EK edited the manuscript to the final draft. All authors approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.