The development of cytomegalovirus encephalitis in AIDS patients receiving ganciclovir.
OBJECTIVE
Cytomegalovirus (CMV) retinitis in patients with the acquired immunodeficiency syndrome (AIDS) requires lifelong therapy with either intravenous ganciclovir sodium or foscarnet sodium. From June 1989 through February 1992, seven patients with AIDS were diagnosed to have CMV retinitis, and all were treated with ganciclovir. Five of the seven developed abrupt preterminal mental status changes. All five with mental status changes received anti-CMV therapy until the time of death. Autopsies were performed in all cases to determine the cause of mental status changes.


METHODS
Five patients with AIDS and newly diagnosed CMV retinitis. Retrospective case analyses with autopsies. All five patients were treated with gangciclovir immediately upon the diagnosis of CMV retinitis and received ganciclovir at standard dosages until death.


RESULTS
Four patients had clinically stable retinitis throughout the entire course of ganciclovir therapy. In the fifth patient, because of fundoscopic deterioration, foscarnet therapy was initiated 1 month prior to death. Cerebrospinal fluid analysis and magnetic resonance imaging, although abnormal, were not diagnostically specific. Neuropathologic examination revealed fulminant diffuse CMV encephalitis in all patients, with prominent ependymal and periventricular necrosis.


CONCLUSIONS
These results suggest that while ganciclovir therapy may clinically stabilize CMV retinitis in patients with AIDS, it does not appear to prevent the development of, or be effective in the treatment of, CMV encephalitis. Thus, clinicians should consider the diagnosis of CMV encephalitis in patients receiving ganciclovir who develop mental status changes and, if possible, alter therapy accordingly.
Berman
S M
SM
Department of Internal Medicine, Veterans Affairs Medical Center, Long Beach, California 90822.
Kim
R C
RC
D017088:AIDS-Related Opportunistic Infections / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D000328:Adult; D000368:Aged; D002552:Cerebral Ventricles / Q000382:microbiology / Q000473:pathology; D003221:Confusion / Q000209:etiology; D003586:Cytomegalovirus Infections / Q000134:cerebrospinal fluid / Q000209:etiology* / Q000473:pathology; D017726:Cytomegalovirus Retinitis / Q000150:complications / Q000188:drug therapy*; D003704:Dementia / Q000209:etiology; D004660:Encephalitis / Q000134:cerebrospinal fluid / Q000209:etiology* / Q000382:microbiology* / Q000473:pathology; D017245:Foscarnet / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015774:Ganciclovir / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D012894:Sleep Stages; D015996:Survival Rate
D017245:Foscarnet; D015774:Ganciclovir