A 3.5-yr-old asymptomatic female Asian elephant (Elephas maximus) with a high load of circulating EEHV1B DNA on qPCR on a routine blood sample, showed progressive depletion of monocytes, lymphocytes, and platelets. Twice daily IV ganciclovir, plasma transfusions, and fluid therapy coincided with a decreasing viral load, which may support potential efficacy of this antiviral drug. An increase in lymphocytes followed initial treatment and preceded the onset of clinical signs. Administration of short-acting glucocorticosteroids for two consecutive days preceded a reduction of lymphocytes, recovery and maturation of monocytes, and gradually decreasing clinical signs, illustrating the potential value of glucocorticosteroids in treatment of clinical EEHV. Three subsequent subclinical episodes with high monocyte and platelet counts did not require intervention. Decision-making was led not just by quantification of viral load and clinical signs, but more specifically by interpretation of the hematological changes using easily accessible, in-house blood smear analysis.