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Multifocal cytomegalovirus demyelinative polyneuropathy associated with AIDS
1Department of Pathology, Mount Sinai Medical Center, New York, NY 10029.
Muscle & Nerve
|February 1, 1994
Summary
Cytomegalovirus (CMV) infection can cause a rare, progressive demyelinating polyneuropathy in patients with acquired immunodeficiency syndrome (AIDS). This case highlights the unusual presentation and challenges in treating AIDS-associated neuropathies.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Acquired immunodeficiency syndrome (AIDS) can be associated with various peripheral neuropathies.
- Cytomegalovirus (CMV) is a common opportunistic infection in advanced HIV/AIDS.
Observation:
- A 47-year-old male with AIDS presented with progressive lower extremity sensory abnormalities and multifocal weakness.
- Electrophysiology showed a generalized asymmetric demyelinating polyneuropathy with secondary axonal loss.
- Despite treatments including plasmapheresis, corticosteroids, IVIG, and ganciclovir, the neuropathy worsened.
Findings:
- Autopsy revealed a multifocal CMV polyradiculoneuropathy with demyelinative and necrotizing features.
- This presentation of CMV as a primary demyelinating polyneuropathy is clinically unusual.
- CMV polyradiculoneuropathy contributed to the patient's fatal bronchopneumonia.
Implications:
- CMV infection should be considered in the differential diagnosis of demyelinating polyneuropathies in AIDS patients.
- Early diagnosis and targeted antiviral therapy may be crucial for managing CMV-associated neuropathies.
- Understanding this rare presentation can inform therapeutic strategies for peripheral nerve complications in AIDS.