Encephalitis by Epstein Barr Virus in a Transplant Immunosuppressed Patient

Encephalitis due to Epstein-Barr Virus (EBV) is a rare condition that primarily affects children and immunosuppressed patients. Diagnosing EBV encephalitis can be challenging due to its nonspecific clinical presentation and the lack of confirmatory tests. We present the case of a 66-year-old woman with a history of kidney transplantation who was admitted due to progressive subacute mental deterioration, preceded by vertigo and without fever. Physical examination revealed no cranial nerve abnormalities, focal neurological deficits, or meningeal signs. Cerebrospinal fluid (CSF) analysis showed a mild increase in protein and pleocytosis (13/µL) without hypoglycorrhachia. Brain magnetic resonance imaging (MRI) revealed multiple bi-hemispheric supratentorial hyperintensities associated with mild vasogenic edema, most prominent at the cortico-subcortical interface, hippocampal regions, and basal ganglia. An extensive search for microorganisms identified EBV by RT-PCR in the CSF (1,650 copies/mL). The patient initially received acyclovir without improvement but achieved rapid recovery after switching to ganciclovir. The patient was discharged, and outpatient follow-up visits demonstrated full recovery. This case supports the effectiveness of ganciclovir, as observed in previous reports. Overall, patients with EBV encephalitis generally have a benign course with complete recovery or mild sequelae.