[Cytomegalovirus ascending myelitis in an immunocompetent adult]

A 32-year-old man was hospitalized because of tetraparesis, sensory loss below cervical line, and urinary bladder dysfunction. Two months prior to this admission, he had suffered from cytomegalovirus (CMV) mononucleosis characterized by fever, presence of atypical lymphocytes and high serum titers of CMV-IgG/IgM antibodies. A lumbar puncture yielded clear fluid with 104 leukocytes (predominantly mononuclear cells)/mm3; protein, 102 mg/dl; and CMV-IgG antibodies (EIA), 1210. CMV antibody serum/CSF ratio was decreased to 2.08 (normal range > or = 20), indicating intrathecal production of CMV antibodies. T2-weighted images of spinal MRI showed diffuse high signal intensity lesions throughout the cord below C3 vertebral body level. A diagnosis of ascending myelitis secondary to CMV infection was made. Methylprednisolone pulse therapy led to some improvement in his neurologic dysfunctions. This is the first case report of CMV ascending myelitis in a previously healthy adult.