Why the study?
Cytomegalovirus typically causes subclinical infection in immunocompetent hosts, and neurological complications such as encephalitis are exceedingly rare in this population.
Highlights the diagnostic challenges of atypical CMV-associated rhombencephalitis in immunocompetent individuals and the potential for spontaneous recovery without antiviral therapy.
Answers are grounded in this paper and cite their sources.
Consider CMV encephalitis in acute brainstem syndromes even among immunocompetent hosts; extends the known spectrum but remains hypothesis-generating.
Cytomegalovirus (CMV) is a ubiquitous virus that typically causes subclinical infection in immunocompetent hosts. Neurological complications, particularly encephalitis, are exceedingly rare in this population. We present a case of a previously healthy young man who developed an acute brainstem syndrome characterised by dysarthria, ataxia, and altered consciousness. Early investigations were inconclusive, with bland cerebrospinal fluid (CSF) findings despite raised opening pressure and normal initial MRI. Repeat imaging revealed a subtle medullary lesion, while serology demonstrated primary CMV infection with detectable viraemia and negative CSF CMV polymerase chain reaction (PCR), consistent with a post-infectious mechanism. The patient made a steady, spontaneous recovery without antiviral therapy. This case highlights the diagnostic challenges posed by atypical presentations of CMV-associated rhombencephalitis in immunocompetent individuals, the value of repeat neuroimaging and serological testing, and the importance of multidisciplinary decision-making to avoid unnecessary treatment in selected cases.
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Hadia Saeed (2025) studied this question.
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