Diagnosis of Cytomegalovirus Meningoencephalitis by Polymerase Chain Reaction in an Immunocompetent Infant Who Recovered After Treatment with Ganciclovir

Cytomegalovirus (CMV) infection of the CNS is rarely observed in immunocompetent infants after the first month of life. Until recent molecular techniques became available, this infection was diagnosed exclusively on the basis of the results of CSF culture and of immunohistochemical studies of a brain biopsy specimen. The outcome of this infection was poor in most instances but improved when ganciclovir became available. We describe a patient with CMV encephalitis who recovered after receiving treatment with ganciclovir. A 6-week-old boy was born in the city hospital of Saint Nicolas after a normal term delivery. His mother had been treated with amoxicillin/clavulanic acid for postpartum endometritis; her bacterial cultures were negative. The infant was breast-fed during the first week of life. From the age of 5 weeks, convulsions of the right arm and leg were noted; these convulsions evolved to generalized convulsions. A CT scan of the brain showed ventricular dilatation and a periventricular low-density lesion in the deep white matter of the right parieto-occipital region that was confirmed by an MRI scan Bacterial and serial viral cultures (including those for CMV) of urine, saliva, and CSF as well as PCR for detection of herpes simplex in the CSF remained negative. An electroencephalogram showed bilateral high voltage paroxysmal discharges. The patient had progressive hydrocephaly and protracted convulsions. Nine days after admission, cultures of saliva yielded CMV. On day 11, CMV was detected in the CSF by PCR (this procedure was previously described by Bale et al).