CASE REPORT article
Front. Oncol.
Sec. Head and Neck Cancer
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1608787
Acute intracranial EBV and CMV infections after chemoimmunotherapy for EBV-associated nasopharyngeal carcinoma: a case report and literature review
Provisionally accepted
- Cancer Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
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A 36-year-old male patient presented to our hospital complaining of epistaxis for 3 months and persistent headaches with facial numbness for 3 days. After a series of exams, he was diagnosed with nasopharyngeal carcinoma (T4N2M1, stage ⅣB, AJCC 8th), with a biopsy consistent with non-keratinizing squamous cell carcinoma, and received a combination therapy of gemcitabine, cisplatin, and tislelizumab. Following the first dose, headaches and facial numbness were relieved. On the third day, however, he developed recurrent fever, with a peak body temperature of 39.2 ℃, and developed severe paroxysmal stabbing pain in the right frontal region suggestive of trigeminal neuralgia, along with numbness on the right face. We considered multiple possibilities and provided symptomatic treatments, but with poor efficacy. Subsequently, given the emergence of prominent neurological symptoms and fever, we proceeded with a lumbar puncture for cerebrospinal fluid (CSF) analysis. Metagenomic next-generation sequencing (mNGS) of CSF detected the presence of Epstein-Barr virus (EBV) and cytomegalovirus (CMV), and acute intracranial viral infections were considered. After treatment with ganciclovir, the patient's body temperature returned to normal, and headaches and facial numbness were alleviated, and no pathogens were detected in a follow-up examination. We report a case of trigeminal neuralgia emerging post-chemoimmunotherapy, accompanied by CSF positivity for EBV and CMV, where antiviral intervention with ganciclovir resulted in significant symptom alleviation.
Keywords: nasopharyngeal carcinoma, Trigeminal Neuralgia, acute intracranial EBV and CMVinfections, case report, Ganciclovir
Received: 09 Apr 2025; Accepted: 23 Sep 2025.
Copyright: © 2025 Zhang, Lin, Song, Yi, Zhou and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Hechao Zhou, zhc993@126.com
Zumin Xu, zuminxu@gdmu.edu.cn
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