Cytomegalovirus Encephalitis in a Heart Transplant Recipient Presenting With Behavioral Changes and Functional Neurologic Deficits.

BACKGROUND

Cytomegalovirus (CMV) encephalitis is a rare but serious complication in immunocompromised patients, particularly transplant recipients as they are heavily immunosuppressed.

CASE SUMMARY

We report the first documented case to our knowledge of CMV encephalitis in a 67-year-old male heart transplant recipient, confirmed by cerebrospinal fluid polymerase chain reaction. The patient presented with confusion and distinct behavioral changes, yet brain magnetic resonance imaging revealed no acute abnormalities.

DISCUSSION

This case highlights the potential for CMV encephalitis to present with significant neurologic symptoms without any radiologic abnormalities, emphasizing the importance of molecular diagnostics in immunocompromised patients with unexplained neurologic deterioration.

TAKE-HOME MESSAGES: CMV encephalitis in transplant recipients can present with significant neurologic symptoms despite normal brain magnetic resonance imaging, necessitating cerebrospinal fluid analysis for timely diagnosis and management. Close monitoring of CMV viremia and neurologic status is critical, as clinical improvement may lag behind virologic clearance, necessitating individualized treatment strategies.