Case Report

Encephalopathy Associated with Severe Cytomegalovirus Infection in an Immunocompetent Young Woman

Table 1

Laboratory investigations

InvestigationsResult on admissionResults two weeks after the admissionResults four months after the admission

WBC (/µl), (3500–9700)1153076006800
Differential count (%)N 47.0, L 27.0, M 3.0, A 23.0N 68.0, L 25.4, M 6.6, A 0N 60.5, L 34.9, M 4.6, A 0
Hemoglobin (g/dl), (11.2–15.2)12.412.212.5
Platelet count (×109/L), (14.9–37.9)22.230.323.1
CRP (mg/dl), (<0.3)3.340.040.04
HBV, HCV serologyNegative
Serum HIV antibodyNegativeNegative
Blood HIV RNANegative
AST (U/l), (8–38)1162021
ALT (U/l), (4–44)1832216
Glucose (mg/dl), (70–109)14015893
CSF counts (cells/mm3)WBC 186 (N 6, L 180)WBC 21 (N 0, L 21)
CSF glucose (mg/dl), (50–75)9658
CSF protein (mg/dl), (15–45)4137
CSF gram stain and cultureNegative
CSF TB-PCRNegative
CSF fungal cultureNegative
Nasopharynx influenza antigen (A and B)Negative
Nasopharynx COVID-19 RNANegative
Blood CMV pp65 antigenemia (0 pp65-positive cells per 5 × 105 cells)Positive (17)Negative (0)Negative (0)
Blood CMV DNAPositive (1.6 × 103 copies/ml)Negative
CSF CMV DNANegative
Serum anti-CMV IgM (<0.8 titers)Positive (8.54)Positive (7.49)Positive (2.99)
Serum anti-CMV IgG (<2.0 titers)Positive (15.5)Positive (71.0)Positive (42.5)
CSF HSV DNANegative
Serum anti-HSV IgM (<0.8 titers)Negative (0.28)
Serum anti-HSV IgG (<2.0 titers)Negative (<2.0)
Blood EBV DNAPositive (2.93 log IU/ml)Negative
CSF EBV DNANegative
Serum anti-EBNA IgG (<0.5 titers)Positive (4.0)Positive (3.1)Positive (4.3)
Serum anti-VCA-IgM (<0.5 titers)Positive (12.7)Positive (8.9)Positive (1.4)
Serum anti-VCA-IgG (<0.5 titers)Positive (8.2)Positive (8.3)Positive (8.4)
Serum anti-VZV IgM (<0.8 titers)Positive (1.32)Positive (1.48)Negative (0.62)
Serum anti-VZV IgG (<2.0 titers)Positive (89.0)Positive (74.0)Positive (55.6)
Serum antimumps IgM (<0.8 titers)Positive (2.9)Positive (2.58)Borderline (0.82)
Serum antimumps IgG (<2.0 titers)Positive (47.0)Positive (39.0)Positive (23.5)
Serum interleukin-6 (pg/ml), (<4)10.32.4

Normal ranges are given in parentheses. WBC, white blood cell; N, neutrophils; L, lymphocytes; M, monocytes; A, atypical lymphocytes; CRP, C-reactive protein; AST, aspartate aminotransferase; ALT, alanine aminotransferase; HBV, hepatitis B virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus; CSF, cerebrospinal fluid; TB, tuberculosis; PCR, polymerase chain reaction; CMV, cytomegalovirus; HSV, herpes simplex virus; EBV, Epstein–Barr virus; EBNA, Epstein–Barr virus nuclear antigen; VCA, virus capsid antigen; VZV, varicella-zoster virus; IgM, immunoglobulin M; IgG, immunoglobulin G.