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Cytomegalovirus-associated transverse myelitis in a non-immunocompromised patient
D Karacostas1, C Christodoulou, A Drevelengas
1B' Department of Neurology, AHEPA Hospital, Aristoteleian University School of Medicine, Thessaloniki, Greece.
Design:
Single case report.
Objective:
To report a rare case of cytomegalovirus (CMV)-associated transverse myelitis (TM) in the immunocompetent host.
Settings:
Collaboration between a Neurology and Radiology University Department in Greece and a Molecular Virology Department in Cyprus.
Patient:
A 16-year-old male student developed an acute febrile illness followed shortly by TM, that resulted in paraplegia over 24 h. Rapid clinical improvement was followed by complete recovery in 2 months. Extensive laboratory work-up excluded other possible causes of TM and showed no evidence of an immunocompromised state. Antiviral serological data, identification of the viral genome by polymerase chain reaction and serial spinal cord magnetic resonance imaging findings, supported the diagnosis of CMV-associated TM in a non-immunocompromised patient.
Conclusions:
Our case further indicates that CMV infection should be included in the differential diagnosis of TM of uncertain etiology, in the immunocompetent patient. Clinical, immunological and neuroimaging findings indicate that post-infectious immune mediated inflammation, seems the most probable pathogenetic mechanism in this case.