351. It’s Not Always Tuberculosis: Cytomegalovirus polyradiculopathy and encephalitis in two Filipino men with advanced HIV infection
Session: Poster Abstract Session: CNS Infections
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • Valencia_351.pdf (838.7 kB)
  • Background: Polyradiculopathy (PRP) and encephalitis are neurologic syndromes associated with 1% of cytomegalovirus (CMV) disease among patients with advanced HIV infection. Untreated patients die within 8 weeks. This case series and literature review highlights the clinical and laboratory features integral to the prompt diagnosis and treatment of these rare but serious manifestations of CMV disease among AIDS patients

    Methods: We document CMV PRP and encephalitis in two HIV-seropositive men seen in a tertiary hospital in the Philippines. Both patients presented with bilateral leg weakness, paresthesias, hyporeflexia and urinary retention associated with confusion and memory lapses. In the two cases described, diagnosis of CMV disease was delayed because it was not immediately entertained. Tuberculosis involving the nervous system was first ruled out.

    Results: The first case was a 31-year-old male with a baseline CD4 count of 9 cells/mm3 who presented with signs and symptoms of bilateral leg weakness and paresthesias three weeks after initiation of antiretrovirals (ART). CMV viremia was detected by PCR. Ganciclovir was initiated late, and he subsequently died of multi-organ failure. The second case is a 29-year-old male with a baseline CD4 count of 2 cells/mm3. CMV DNA PCR was detected in the CSF. He died prior to initiation of anti-CMV therapy.

    Conclusion: CMV-related neurologic complications are uncommon, but often fatal when appropriate anti-CMV therapy is not initiated promptly. The diagnosis of CMV PRP should be considered in patients with advanced immunosuppression presenting with ascending paraplegia, areflexia and urinary retention with typical CSF abnormalities (polymorphonuclear pleocytosis, elevated protein concentration and hypoglycorrhachia).

    Table 1. Summary of presenting signs and symptoms of the two cases in comparison to the 103 patients with CMV PRP in Anders and Goebel’s review.

     

    Sign or Symptom

    Anders & Goebel [2]

    Case 1

    Case 2

    Lower limb weakness

    100%

    Present

    Present

    Lower limb areflexia

    100%

    Present

    Present

    Urinary retention

    94%

    Present

    Present

    Paresthesia

    79%

    Present

    Present

    Sensory loss (legs)

    72%

    Present

    Present

    Fecal incontinence

    67%

    Absent

    Absent

    Lumbar pain

    36%

    Absent

    Absent

    Babinski sign

    16%

    Absent

    Absent

     

    Jose Carlo Valencia, MD, Marissa Alejandria, MD, MSc and Maria Sonia Salamat, MD, Section of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines

    Disclosures:

    J. C. Valencia, None

    M. Alejandria, None

    M. S. Salamat, None

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