Abstract
Background Cytomegalovirus (CMV) is a herpesvirus with a wide array of clinical presentations. CMV encephalitis is associated with immunosuppression or congenital infection, often resulting in severe long-term sequelae. Neurological manifestations of CMV in healthy individuals is of unclear significance.
Case Presentation A 27 year old female presented to hospital with one week of headaches, fevers, and malaise. Relevant past history included symptomatic Epstein Barr Virus (EBV) infection at age 15. Initial assessment demonstrated tender hepatosplenomegaly confirmed on computed tomography, inflammation with CRP (75) and ferritin (1636), and transaminitis with ALT (588). Serology demonstrated EBV IgG+ and IgM+, and CMV IgM+ and IgG+ with low avidity. Lumbar puncture was performed due to persistent headaches, photophobia, and new right abducens nerve palsy. CSF opening pressure was 26cmH2O without other abnormality. MRI brain demonstrated a 13 x 8 mm ovoid lesion within the splenium of her corpus callosum with associated restricted diffusion, hyperintense T2 signal, low T1 signal and no contrast enhancement with gadolinium.
She was treated with three days of pulse IV methylprednisolone. She rapidly made a complete recovery with repeat MRI five days later demonstrating near complete resolution of her splenium lesion. CMV IgG avidity was raised six weeks later suggesting this inflammation was associated with acute CMV infection.
Conclusion This presentation of CMV with a cytotoxic lesion of the corpus callosum provides ongoing evidence for an association between herpesviruses and central nervous system inflammation - relevant in a growing body of evidence associating demyelinating disorders with herpesviruses.
