Simultaneous cytomegalovirus and herpesvirus meningitis in an adolescent immunocompetent patient: a case report

Background: Viral meningitis is an inflammatory condition of the meninges that manifests as neurological dysfunction with variable clinical signs, ranging from mild manifestations (such as headache) to seizures and intracranial hypertension. The clinical presentation can vary with the patient's age, immune status, and etiology of the disease, with many symptoms being nonspecific. Coinfections in central nervous system (CNS) infections are rare, more commonly observed in immunocompromised patients. We report the first known case of viral meningitis due to concurrent cytomegalovirus (CMV) and herpes simplex virus type 2 (HSV-2) in an immunocompetent adolescent, highlighting a significant clinical consideration in the management of similar cases. Case Description: We present a case from March 2021 involving a 16-year-old previously healthy Latin male adolescent with no known immunity-related abnormalities, who presented diarrhea with macroscopic blood, headache, and fever. He was diagnosed with a rare viral coinfection of CMV and HSV-2 meningitis. Investigations to rule out primary or secondary immunodeficiency showed no abnormalities. The patient received antiviral therapy for 21 days with ganciclovir (5 mg/kg/dose), leading to a favorable outcome without subsequent neurological deficit or adverse events. Conclusions: This case enriches clinical practice by demonstrating effective management in an unlikely host, thereby broadening our understanding of viral meningitis in immunocompetent patients and informing future diagnostic and treatment strategies.