[Cytomegalovirus encephalitis in immunologically normal adults].

We report two cases of cytomegalovirus (CMV) encephalitis in immunologically normal adults. Patient 1, a 53-year-old man: onset was acute with headache and pyrexia, followed by moderate disturbance of consciousness with meningeal signs. Repeated lumbar puncture revealed 58 CSF cells per microliters and 96 mg protein per dl. On the 11th day after onset, we started treatment with adenine arabinoside (ara-A). He recovered completely. With IgG-ELISA methods, antibody to CMV turned into positive on the third week, and into negative again on the fifth week, and these conversions were concomitant with the symptomatic aggravation and amelioration, respectively. Patient 2, a 78-year-old woman: onset was acute with general fatigue and pyrexia, followed by meningeal signs and mild disturbance of consciousness. Consciousness level was worsened and two courses of acyclovir (Acv) treatment were started on the 59th and on the 93rd day after onset, but consciousness level went down to coma and she died. Repeated lumbar puncture revealed 787 CSF cells per microliters and 229 mg protein per dl. CMV antibody titer (CF) in CSF was 1:32 and antibody index was 58 or more, suggesting antibody production in central nervous system. CMV encephalitis in immunologically normal adults is very rare, only 10 cases having been reported so far. Most patients recover spontaneously, but some may be fatal. In our view ara-A treatment should be taken in consideration in case of acute encephalitis unresponsive to Acv.