Clinical presentation of cytomegalovirus meningoencephalitis: a retrospective study of 12 adult patients with a variety of immunocompromised conditions.

BACKGROUND

Human Cytomegalovirus (HCMV) is a crucial pathogen in immunocompromised individuals, causing infections such as pneumonitis, colitis, and retinitis. However, research on HCMV infections of the central nervous system (CNS) is limited.

OBJECTIVE

This retrospective cohort study aimed to investigate the clinical manifestations, underlying conditions, laboratory findings, imaging findings, treatments, and outcomes of adult patients diagnosed with HCMV meningitis or encephalitis at a single medical center in East Asia over a 6-year period.

METHODS

The study included patients who had positive results in quantitative polymerase chain reaction (PCR) tests of their cerebrospinal fluid (CSF) for HCMV at any time between January 2017 and December 2022. Clinical characteristics, laboratory findings, imaging findings, treatment approaches, and outcomes were reviewed and analyzed from electronic medical records.

RESULTS

The cohort comprised 12 patients with a median age of 61 years (range, 43-84 years). Stupor and generalized seizures were the most common neurological presentations. Brain imaging findings in half of the patients revealed nonspecific abnormalities, such as atrophy. CSF protein levels were elevated, with a median of 74.5 mg/dL. CSF pleocytosis was observed in three patients (25%) and was predominantly lymphocytic. The in-hospital mortality rate was 75% (9 out of 12 patients).

CONCLUSIONS

Although rare, HCMV CNS infections are associated with a high mortality rate. CSF pleocytosis is uncommon in such cases, potentially contributing to clinical misdiagnosis or underestimation. HCMV meningoencephalitis should be considered in immunocompromised patients who present with unexplained seizures or altered consciousness.