Abstract

Background: Cytomegalovirus (CMV) encephalitis is extremely rare in immunocompetent individuals and often underrecognized. The limited number of published reports contributes to delayed diagnosis and treatment.
Objective: To present a rare case of CMV meningoencephalitis successfully treated at Hue Central Hospital, Vietnam, and to review the literature on CMV encephalitis in immunocompetent patients.
Case: A 67-year-old male patient with no history of immunodeficiency was hospitalized for a persistent headache. After multiple lumbar punctures and antibiotic treatment without response, the PCR result of CSF was positive for CMV and negative for HSV. The patient was diagnosed with CMV meningoencephalitis, treated with oral valganciclovir for 6 weeks, with complete clinical improvement and no sequelae.
Conclusion: This case supports existing evidence that CMV can cause isolated encephalitis in immunocompetent hosts. CSF PCR is essential for early and accurate diagnosis. Oral valganciclovir was effective in the absence of intravenous ganciclovir, making it a viable option in resource-limited settings. Clinicians should consider CMV as a potential etiology in patients with unexplained encephalitis, especially when HSV PCR is negative.