Multifocal cytomegalovirus demyelinative polyneuropathy associated with AIDS.
A 47-year-old man with acquired immunodeficiency syndrome presented 3 months antemortem with the onset of lower extremity sensory abnormalities. A progressive course of multifocal weakness and sensory disturbances ensued. Electrophysiologic studies revealed a generalized asymmetric demyelinating polyneuropathy with secondary axonal loss. The patient was sequentially treated with plasmapheresis, high dose corticosteroids, intravenous immune globulin, and ganciclovir. His neuropathy progressed, and he died of a fulminant bronchopneumonia. At autopsy the patient had a multifocal cytomegalovirus polyradiculoneuropathy, with both demyelinative and necrotizing features. While cytomegalovirus may be associated with a variety of peripheral nerve syndromes, its clinical presentation as a primary demyelinating polyneuropathy is unusual. Its importance vis-à-vis potential therapy for AIDS-associated neuropathies is discussed.
Morgello
S
S
Department of Pathology, Mount Sinai Medical Center, New York, NY 10029.
Simpson
D M
DM
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D001917:Brachial Plexus / Q000473:pathology; D001921:Brain / Q000473:pathology; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000473:pathology; D003711:Demyelinating Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D004576:Electromyography; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D013979:Tibial Nerve / Q000473:pathology