A 63-year-old woman was admitted to our hospital to receive a fourth course of modified
rituximab-ESHAP
chemotherapy for relapsed primary breast
diffuse large B-cell lymphoma. She developed
hemophagocytic lymphohistiocytosis (HLH) 20 days after admission. Polymerase chain reaction (PCR) detected cytomegalovirus (CMV)
DNA in her peripheral blood; therefore, she was diagnosed with CMV-associated HLH and consequently treated with
foscarnet (FCN). Her general condition and
pancytopenia soon improved, and the
antiviral drug was stopped for 1 week. However, she suddenly became disoriented 10 days later, and this condition rapidly worsened. Cerebrospinal fluid (CSF) examination revealed an elevated white blood cell count with lymphocytic predominance and a high CMV
DNA load, prompting a final diagnosis of CMV
meningoencephalitis. We began intravenous combination
therapy with FCN and
ganciclovir (GCV), and her conscious state gradually improved. CMV
DNA sequencing did not reveal drug resistance associated with mutations, and intravenous GCV was stopped for 1 week. FCN treatment was then continued until CMV
DNA was no longer detected in her CSF samples via PCR. CMV
meningoencephalitis is a rare neurological
infection complicated with
hematological malignancy in non-transplant patients and can be serious and life-threatening with a high mortality rate. This
infection requires a differential diagnosis of consciousness impairment that develops in a patient with lymphoid
malignancy during
chemotherapy.