SHM Converge Scientific Abstract ePoster Gallery-A Mystery Case of Acute Mania in a Geriatric Patient: Could an Acute Epstein-Barr Viral Infection Be a Possible Culprit?

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This case report describes a 75-year-old man with osteomyelitis and heart failure who was admitted after a seizure with rapid, pressured speech, delusions, and encephalopathy. Initial evaluation included broad bloodwork, EEG, lumbar puncture, and cerebrovascular workup. EEG showed diffuse encephalopathic slowing for several days, but CSF studies did not reveal bacterial or fungal infection, and stroke evaluation was negative. His psychiatric and mental status symptoms improved markedly by hospital day 6.<br /><br />During the admission, he developed new focal neurologic findings, including tongue deviation, delayed palate elevation, shoulder weakness, bilateral triceps weakness, and progressive dysphagia. Despite these deficits, he gradually improved over the following days and weeks. He was discharged to subacute rehabilitation on day 29, tolerating oral intake with mild residual dysphagia, and later had complete resolution of psychiatric and neurologic symptoms at 3-month follow-up. Valproic acid was eventually stopped.<br /><br />The authors argue that acute Epstein-Barr virus (EBV) infection may have contributed to this unusual presentation of acute mania/encephalopathy in an older adult. They note that EBV is often not considered in geriatric patients because many have prior exposure and may lack classic symptoms such as fatigue, splenomegaly, or cervical lymphadenopathy. However, EBV IgM is a highly specific marker of acute infection. The report also discusses prior literature linking EBV to psychosis, encephalitis, facial palsy, and possible inflammatory neuropsychiatric effects.<br /><br />The authors conclude that when common causes of encephalopathy, stroke, metabolic disturbance, and autoimmune disease have been excluded in an elderly patient, EBV should remain on the differential diagnosis.

Asset Subtitle

Thomas A. Kotsonis

Meta Tag

Author List Brian Kelley, Cole Starkey, Imeh Ndiokho, Lolia Abibo, Thomas A. Kotsonis

Category Clinical Vignettes

Concept Epstein-Barr Virus Infection

Concept Neuropsychiatric Symptom

Concept Geriatric Patient

Concept Diagnostic Workup

Concept EBV IgM

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Thomas A. Kotsonis

Track Adult

Keywords

Epstein-Barr virus

EBV infection

acute mania

encephalopathy

elderly patient

seizure

dysphagia

neurologic deficits

psychosis

case report

Epstein-Barr Virus Infection

Neuropsychiatric Symptom

Geriatric Patient

Diagnostic Workup

EBV IgM