A severe case of Cytomegalovirus (CMV) meningoencephalitis in an otherwise healthy immunocompetent 2 month old male. (P5.138)

Objective: To report a case of Cytomegalovirus (CMV) meningoencephalitis in an otherwise healthy, immunocompetent 2 month old male with severe complications of ischemic stroke, seizures, and diffuse cystic encephalomalacia. Background: Cytomegalovirus (CMV) causes severe illness in immunocompromised individuals and those infected congenitally. In the vast majority of immunocompetent patients, CMV infection is asymptomatic or associated with a mononucleosis-like illness, due to a cell mediated immune response. We present a unusually severe case of CMV meningoencephalitis in an otherwise healthy, immunocompetent infant complicated by central line associated thrombosis, global diffusion restriction, ischemic stroke, seizures, cerebral volume loss, and cystic encephalomalacia. A previously healthy 2-month-old male presented with fever and seizures. CSF studies, head CT, and brain MRI were normal on admission. After a clinical decline on day 2 of admission a repeat head CT showed loss of gray-white matter differentiation. A repeat brain MRI on day 5 revealed diffuse restricted diffusion on diffuse weighted imaging, acute infarction of the right posterior inferior cerebellar artery territory, and left frontoparietal cortex FLAIR hyperintensity favored to represent cortical necrosis versus focal leptomenigeal enhancement. Design/Methods: Case report and literature review Results: A repeat LP was performed on day 5 and showed a total nucleated cell count of 42 cells/mm^3 with 39% lymphocytes and 61% monocytes, glucose 52 mg/dL. A viral panel was sent on the CSF sample later on Day 11 of hospitalization. This PCR panel was positive for CMV. Serum quantitative CMV PCR was positive with 2,510 IU/ml. He began 2 weeks of IV ganciclovir and then 6 months of oral valganciclovir for viral suppression therapy. The patient showed clinical improvement, although repeat imaging found cystic encephalomalacia with diffuse cerebral volume loss, indicating a high likelihood of severe long-term neurological dysfunction. Conclusions: CMV should be considered as an etiology for viral meningoencephalitis even in immunocompetent patients. Disclosure: Dr. Gervelis has nothing to disclose. Dr. Davis has nothing to disclose. Dr. Singhal has nothing to disclose. Dr. Christenson has nothing to disclose. Dr. Conrad has nothing to disclose.