a 49-year - old man ( taxi driver ) sought treatment during the winter of 2009 . he had a 7-day history of fever , chills , headache , nausea , vomiting , neck rigidity , generalized weakness , and paresthesias in his fingers . csf showed leukocytes 871 cells/l ; erythrocytes 2 cells/l , with 93% lymphocytes and 7% monocytes ; glucose 32 mg / dl ( serum glucose 93 mg / dl ) ; and protein 185 mg / dl . results of a computerized axial tomography scan of the brain and chest radiograph were unremarkable . a complete blood count and results of serum chemical tests and liver function tests were unremarkable . blood cultures yielded no growth . results for syphilis rapid plasma reagin , cryptococcal antigen , and hiv testing were negative . because of the patient s hypoglycorrachia , pronounced csf leukocytosis , and negative csf cultures , acute infection with lcmv was considered . serum tested at a commercial laboratory was positive for lcmv ( immunoglobulin [ ig ] g titer > 256 ( reference < 16 ) and igm titer 80 ( reference < 20 ) by immunofluorescence assay . csf collected on day 1 and serum collected on days 7 and 15 was tested for lcm antibodies by the centers for disease control and prevention s special pathogens branch using elisa . csf and serum were both igm and igg positive and a 4-fold rise in acute - phase and convalescent - phase serum titers indicated the patient had a recent infection with lcmv ( table ) . the patient improved with supportive care , recovered fully , and was discharged on day 12 . * csf , cerebrospinal fluid ; lcm , lymphocytic choriomeningitis ; ig , immunoglobulin ; qns , quantity not sufficient . the disease is likely underdiagnosed because only a limited number of commercial laboratories offer lcmv testing . diagnosed cases of lcmv are often identified because they are part of a larger outbreak . since 1960 , only 7 cases have been reported in the literature ( 8,9 ) ; all but 2 had had contact with rodents . several large outbreaks have been reported , often associated with pet hamsters or laboratory mice or hamsters ; 1 outbreak had > 236 human cases ( 8) . a total of 54 cases of congenital lcmv are cited in the literature , 34 since 1993 ( 5 ) . his corneal transplant had occurred > 1 year before , and was unlikely to be the source of infection . a definitive diagnosis was difficult , but testing by centers for disease control and prevention confirmed the diagnosis . new york city health department officials attempted an investigation of the patient s home and surroundings to look for evidence of rodents or rodent excreta , but were unable to do so due to the patient s noncompliance . several clues have assisted clinicians in the identification of patients with acute lcmv infection : 1 ) aseptic meningitis or encephalitis during the fall  winter season , 2 ) a febrile illness followed by brief remission before onset of neurologic illness , and 3 ) csf with a lymphocytosis and hypoglycorrachia . patients with a history of organ transplantation within the preceding 3 months should be fully evaluated to determine whether infected organs were the source of lcmv . we recommend enzyme immunoassay - based testing of csf and serum when lcmv is considered . public health surveillance , rodent control , healthcare provider education , and improved laboratory testing can enhance recognition of illness . health departments should consider making lcmv a reportable condition , and , if aseptic meningitis is reportable , questions should be added to case investigation forms regarding rodent exposure . lcmv was made reportable in new york city in 2009 . only with a better understanding of the true incidence of lcmv will authorities be able to enact measures to better prevent and control this disease in the vulnerable sections of our society .
we describe a case of lymphocytic choriomeningitis virus ( lcmv ) meningitis in a new york , ny , resident who had no apparent risk factors . clues leading to the diagnosis included aseptic meningitis during winter and the finding of hypoglycorrachia and lymphocytosis in the cerebrospinal fluid . 
 lcmv continues to be an underdiagnosed zoonotic disease .