Background: Epstein-Barr virus (EBV) infection is known to cause severe neurological complications such as encephalitis.
Material and methods: We present the history of two men, aged 17 and 22, who developed encephalitis after acute primary EBV infection. One of them survived with cerebral complications, the other died.
Results: One of them had the classic presentation of infectious mononucleosis and EBV-specific findings in the cerebrospinal fluid. The other had neither signs of infectious mononucleosis nor specific findings in the cerebrospinal fluid such as EBV-PCR. Nevertheless, the clinical features of encephalitis were very similar. They were characterized by memory problems, personality changes, reduced consciousness, brainstem disorders and epileptic seizures. CT and MRI findings indicated involvement of basal ganglia and limbic structures. None of them responded to acyclovir.
Interpretation: We conclude that EBV infection can lead to severe cerebral complications without general symptoms of infectious mononucleosis and specific serologic findings in the cerebrospinal fluid.