Abstract

A 73-year-old right-handed woman with alcoholic cirrhosis presented with epilepsia partialis continua, fever, persistent post-ictal confusion and left-sided weakness. Levetiracetam, acyclovir and lacosamide were started, with early investigations showing normocytic anaemia (haemoglobin 85 g/L) but normal cerebrospinal fluid (CSF) white cell count and protein, and negative viral PCR. Brain MRI revealed multifocal T2 hyperintensities with restricted diffusion in right temporal, right frontal, and occipital white matter. Video EEG suggested moderate encephalopathy without epileptiform activity.

While confusion and seizures improved, the weakness and anaemia persisted beyond four weeks. Negative autoimmune and paraneoplastic screens and PET-CT excluded malignancy. Repeat MRI showed persistent lesions with volume loss. Extended investigations for atypical infection revealed positive serum parvovirus B19 IgM and PCR, though CSF parvovirus PCR was negative. The patient received intravenous methylprednisolone followed by five days of intravenous immunoglobulin. She was discharged after 13 weeks, with improved left-sided weakness, controlled seizures, and haemoglobin of 110 g/L.

This case highlights the importance of screening for atypical infections in immunocompromised patients with encephalitis. Parvovirus B19 should be considered when unexplained anaemia and neurological involvement coexist. Interestingly, CSF can be normal in parvovirus infection. She demonstrated clinical improvement and hematologic stability, illustrating the value of prompt diagnosis.