CMV meningitis is a well-documented clinical entity in immunocompromised adults. There are only a few reports in the literature regarding CMV meningitis in immunocompetent adults.
Case report: We present the case of an immunocompetent middle-aged woman who presented with fever, nuchal rigidity, confusion, and vomiting. Lumbar puncture revealed meningitis (550 cells/mm(3), 80% lymphocytes). The patient was commenced empirically on acyclovir intravenously. Polymerase chain reaction for the detection of DNA and RNA viruses in the cerebrospinal fluid was performed. Once results were available, CMV DNA was present in the CSF and ganciclovir substituted the previous therapeutic regimen. The patient made an uneventful recovery.
Conclusions: Our report suggests that CMV meningitis should be included in the differential diagnosis of immunocompetent adults with lymphocytic meningitis. Treatment of CMV meningitis in patients that are not immunocompromised is debatable. Prospective trials will be needed to clarify this issue further. We think that weighing the risk of treatment-associated toxicity against the risk of neurological deterioration due to CMV meningitis mandates the administration of ganciclovir.