Adenovirus causing acute encephalitis in an immunocompetent elderly female - The first case reported in literature

Abstract

Encephalitis is a leading cause of morbidity and mortality in elderly patients. Prognostic factors independently associated with an adverse clinical outcome are age ≥65, fever, Glasgow Coma Scale score <13, and seizures. The most common viruses causing encephalitis are herpes simplex virus, varicella-zoster, human immunodeficiency virus, Epstein–Bar virus, cytomegalovirus, Japanese encephalitis, and arboviruses. We hereby present a case of a 55-year-old female who presented with a new-onset seizure, fever, and altered behavior. She was clinically diagnosed with encephalitis. Her diagnostic lumbar puncture was suggestive of lymphocytic pleocytosis, red blood cells, and raised protein with normal glucose. She had normal magnetic resonance imaging of the brain; however, cerebrospinal fluid demonstrated the presence of adenovirus DNA by real-time polymerase chain reaction. She was managed conservatively; however, the course was complicated by drug-induced acute kidney injury. Our patient had a favorable outcome. To the best of our knowledge, this is the first case of adenovirus encephalitis in an elderly immunocompetent female. Adenovirus is a rare cause of encephalitis in adults; however, high index of suspicion and timely management with available antivirals can lead to successful outcomes.