Blackground: It is well-known that Epstein-Barr virus (EBV) can affect the central nervous system (CNS).\r\nCase presentation: Herein the authors report unusual timely Magnetic Resonance Imaging (MRI) brain scan\r\nfindings in an immunocompetent patient with EBV encephalitis.\r\nDiffusion weighted MRI sequence performed during the acute phase of the disease was normal, whereas the Fast\r\nRelaxation Fast Spin Echo T2 image showed diffuse signal intensity changes in white matter. The enhancement\r\npattern suggested an inflammatory response restricted to the brain microcirculation. Acyclovir and corticosteroid\r\ntherapy was administered. After three weeks, all signal intensities returned to normal and the patient showed\r\nclinical recovery.\r\nConclusion: This report demonstrates that EBV in an immunocompetent adult can present with diffuse, reversible\r\nbrain white matter involvement in the acute phase of mononucleosis. Moreover, our case suggests that a negative\r\nDWI sequence is associated with a favorable improvement in severe EBV CNS infection. More extensive studies are\r\nneeded to assess what other instrumental data can help to distinguish viral lesions from other causes in the acute\r\nphase of disease.
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