How do you approach the management of EBV Meningoencephalitis (CSF pleocytosis and CSF PCR positive for EBV)?

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.
When...

Agree with the above, and would add that:

1. bystander EBV positivity in CSF can be seen in immunosuppressed patients, and
2. 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 patients...