Journal of NeuroVirology

, Volume 24, Issue 6, pp 780–785 | Cite as

Rapidly progressive encephalopathy caused by Coxsackie meningoencephalitis in an elderly male

  • Masoom DesaiEmail author
  • Melissa Motta
Case Report


Enteroviruses and Coxsackie viruses are common causes of aseptic meningitis and encephalitis in children. These infections usually have a benign, self-limited course. However, they can have a florid presentation in immunocompromised patients, such as neonates, patients exposed to immunosuppressive drugs, such as transplant recipients and patients with agammaglobulinemia. We present a rare case of rapidly progressive acute encephalopathy caused by Coxsackie meningoencephalitis and complicated by refractory status epilepticus in an immunocompetent adult male. Our case highlights the importance of having a broad differential in patients presenting with rapidly progressive acute encephalopathy. Although rare, an enterovirus infection caused by a Coxsackie virus subtype can have a severe presentation causing significant morbidity. This case, also underscores the importance of searching for underlying immunodeficiency in malignant presentations of common viral infections. Hence, rapidly progressive acute encephalopathy due to coxsackievirus can occur in immunocompetent individuals. Aggressive and systematic diagnostic and therapeutic approach in such severe cases can influence overall outcomes.


Meningoencephalitis Enterovirus Coxsackievirus Meningoencephalitis in an immunocompetent male Meningitis Encephalitis Meningoencephalitis Rapidly progressive encephalopathy 



polymerase chain reaction


venereal disease research laboratory


human immunodeficiency virus


thyroid stimulating hormone


double-stranded DNA

C. diff

Clostridium difficile


inferior vena cava

Mayo clinic autoimmune and paraneoplastic encephalitis panel consists of VGKC-complex Ab, LGI1-IgG, CASPR2-IgG, GAD65 Ab, CRMP-5-IgG, amphiphysin Ab, anti-neuronal nuclear Ab type 1, anti-neuronal nuclear Ab type 2, Ant-neuronal nuclear Ab type 3, anti-glial nuclear Ab, type 1, Purkinje cell cytoplasmic Ab type 1, Purkinje cell cytoplasmic ab type 2, Purkinje cell cytoplasmic Ab type Tr, amphiphysin Ab, CSF, CRMP-5-IgG


  1. Berger JR, Chumley W, Pittman T, Given C, Nuovo G (2006) Persistent Coxsackie B encephalitis: report of a case and review of the literature. J Neurovirol 12(6):511–516CrossRefPubMedGoogle Scholar
  2. McDonald TJW, Cervenka MC (2017) Ketogenic diets for adults with highly refractory epilepsy. Epilepsy Currents 17(6):346–350CrossRefPubMedPubMedCentralGoogle Scholar
  3. Moore M, Kaplan MH, McPhee J, Bregman DJ, Klein SW (1984) Epidemiologic, clinical, and laboratory features of Coxsackie B1-B5 infections in the United States, 1970-79. Public Health Rep 99(5):515–522PubMedPubMedCentralGoogle Scholar

Copyright information

© Journal of NeuroVirology, Inc. 2018

Authors and Affiliations

  1. 1.Department of Neurology, Division of Neurocritical Care and Program in TraumaUniversity of Maryland Medical CenterBaltimoreUSA
  2. 2.University of Maryland Medical CenterBaltimoreUSA

Personalised recommendations