Visual Summary.

Timeline of Events

Timeline	Events
Day 1	A 67-year-old male heart transplant recipient presented to transplant clinic with progressive malaise, low-grade fever, weight loss, confusion, forgetfulness, and impaired coordination.
Days 1-2	Initial laboratory tests showed acute kidney injury, mild leukopenia, and significantly elevated CMV viral load (17,185,648 copies/mL). Brain MRI showed no acute abnormalities.
Day 2	Initiated intravenous ganciclovir owing to high suspicion of CMV-related central nervous system infection. Immunosuppression adjusted (mycophenolate mofetil withheld, tacrolimus trough target lowered).
Days 2-14	Neurologic status deteriorated, with worsening confusion, hyperreflexia, and repetitive stereotyped movements. MRI obtained, with no acute abnormalities. CSF analysis confirmed CMV encephalitis (CMV PCR positive).
Days 14-20	Continued CMV viremia monitoring; viral load progressively declined. Neurologic improvement correlated with viral load reduction <16,000 copies/mL (around hospital day 20).
Day 21	Marked neurologic and clinical improvement. Increased oral intake led to gradual weaning off enteral nutrition.
Day 29	Discharged with ongoing CMV monitoring and adjusted immunosuppressive regimen. Scheduled follow-up in transplant clinic.

CMV = cytomegalovirus; CSF = cerebrospinal fluid; MRI = magnetic resonance imaging; PCR = polymerase chain reaction.