Atypical presentation of Cytomegalovirus meningoencephalitis in a immunocompetent patient (P5.133)

Objective: We report a case of an atypical presentation of a Cytomegalovirus meningoencephalitis in a person who did not have recently immunodeficience causes. Background: A 62-year-old woman with 2-week-long headache with slightly disorientation. The medical history was constituted by Non-Hodgkin’s Lymphoma 10 years earlier. C eftriaxone was administered as empiric antibiotic coverage after a CT scan showing sphenoid sinusitis. After admission, the confusion progressed and the patient experienced memory impairment and motor agitation. Initial CSF revealed a cloudy aspect, no organisms were observed on Gram stain. CSF cell count was 616×10 6 /L, with lymphocytic predominance. CSF protein 1,77 g/L and glucose 32 mg/dL. Latex agglutination tests, serology and oncotic cytology were negative. MRI of the brain showed a leptomeningeal inflammatory process. Lumbar puncture was repeated 20 days after, showing 160×10 6 /L cells and protein 0,98 g/L. The CSF was sent for BK PCR analysis, as well as for flow cytometry immunophenotypic who turn negative. One month later, the patient experienced motor agitation and speech difficulties. A new MRI showed reduction of the anomalous leptomeningeal impregnation. Although it has been a characterization of multiple foci of cytotoxic edema. Immunohistopathology of brain byopsy revealed Cytomegalovirus inclusions. The patient was began on Ganciclovir for a total of 3 months and achieved significant improvement. Design/Methods: Not applicable Results: Not applicable Conclusions: Some studies in CMV-infected patients have shown that CSF analysis results tend to be variable, including normal findings. The diagnosis of CMV encephalitis is often difficult because of the variable clinical presentation and lack of CSF findings. An interesting and unusual observation in our patient was that CMV infections involving the central nervous system are uncommon in previously healthy individuals, and, whilst meningitis findings were improving in CSF analysis, isolated CMV parenchymal lesions were emerging. Study Supported by: Not applicable Disclosure: Dr. Queiroz has nothing to disclose. Dr. Ferreira Lima has nothing to disclose. Dr. Teixeira has nothing to disclose. Dr. Penteado Lancellotti has nothing to disclose. Dr. Freitas has nothing to disclose. Dr. Baeta has nothing to disclose.