You have to be extremely careful before making this diagnosis. It is known that positive CSF PCR for EBV can be a "bystander" when there is actually another cause of encephalitis that shouldn't be missed. Therefore, one has to make sure that extensive PCR and/or antibody testing in the CSF has been ...

This can be challenging. Although, when the patient presents with a classic prodromal illness with an acute encephalopathy syndrome with positive CSF EBV PCR and serologic evidence of acute Infection( + EBV IgG and IgM VCA, neg EBVNA), and they are immunosuppressed, it’s fairly straightforward...

Agree with the above, and would add that: bystander EBV positivity in CSF can be seen in immunosuppressed patients, and EBV PCR positivity in CSF with pleocytosis in an immunocompromised patient would be a red flag for another process first such as lymphoma in HIV or PTLD in post-transplant patien...