a case of hypogammaglobulinemia with enteroviral meningoencephalitis, associated with increased adenosine deaminase in cerebrospinal fluid

we describe the development of enterovirus meningoencephalitis associated with increased adenosine deaminase in cerebrospinal fluid of a 12-year-old boy, a known case of hypogamaglobulinemia despite monthly replacement of ivig. the patient was referred to our center with fever, headache and vomiting for 10 days. csf analysis was compatible with aseptic meningoencephalitis but high csf protein (>200mg/dl) and high level of adenosine deaminase in csf (30iu/l) were against the diagnosis of simple viral meningoencephalitis. nested pcr of csf for entrovirus was positive. treatment with daily high-dose ivig was commenced, with significant clinical improvement. for patients with increased ada and lymphocytic pleocytosis in csf, differential diagnoses should include enteroviral meningitis. antibodies, although crucial, cannot on their own prevent enteroviral infection in some hypogamaglbulinemic patients.