A case of fulminant Epstein-Barr virus encephalitis in an immune-competent adult

  • Marvyn T. KoningEmail author
  • Tessa Brik
  • Rogier Hagenbeek
  • Ido van den Wijngaard
Case Report


A 21-year-old female presented with headache, nausea and vomiting, dysarthria, difficulty finding words, vertigo, episodical diplopia and an abnormal gait since 2 days. Additionally, we found marked ataxia and disturbed liver chemistry whilst her infection parameters were low. Her head CT scan was unremarkable, but her MRI scan showed leptomeningeal enhancement along the cerebellar folia. A lumbar punction revealed mononuclear leucocytosis and increased protein in her cerebrospinal fluid. She was admitted on a working diagnosis of herpes simplex encephalitis. Shortly after admission, she had a generalised seizure. She was tested for a wide range of viruses, bacteria and auto-immune antibodies and treated empirically with aciclovir, ceftriaxone, doxycycline and intravenous immunoglobulins. All tests continued to come back negative until the fifth day of admission, when repeat Epstein-Barr virus (EBV) serology showed evidence of an acute EBV infection, even though negative tests were acquired at admission. EBV encephalitis is a rare complication of EBV infection that is usually restricted to children and immune-compromised individuals. This is only the fifth case describing EBV encephalitis in an immune-competent adult, presenting with unique clinical features including a lack of fever and leptomeningeal enhancement on MRI investigation. Most interestingly, she tested negative for EBV until a few days after admission, underlining the need for repeated investigations in suspected virological encepahlitis. Even though our patient did not receive the often recommended glucocorticosteroids, she made a good neurological recovery.


EBV Encephalitis Cerebellitis Epilepsy 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Written informed consent for publication was obtained from the patient prior to submission.


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Copyright information

© Journal of NeuroVirology, Inc. 2019

Authors and Affiliations

  1. 1.Department of NeurologyHaaglanden Medical CenterThe HagueThe Netherlands
  2. 2.Department of HematologyLeiden University Medical CenterLeidenThe Netherlands
  3. 3.Department of RadiologyHaaglanden Medical CenterThe HagueThe Netherlands

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