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A severe multifocal neuropathy caused by the cytomegalovirus(CMV-MN)can occur in the late stage of human immunodeficiency virus(HIV)infection.In a retrospective study,we identified 15 consecutive HIV positive patients with a diagnosis of CMV-MN based on(1)markedly asymmetric neuropathy,(2) fewer than 100 CD4 cells per mm,(3)exclusion of other causes of neuropathy,and(4)characteristic CMV cytopathic changes on neuromuscular biopsy(2 patients),positive CSF culture for CMV(2 patients)or clinical improvement on anti-CMV therapy given for concurrent extraneurologic CMV disease(8 patients)or neuropathy(3 patients).All patients were men and had severe immunosuppression(mean CD4 cell count,18 per mm).The initial symptoms were numbness and painful paresthesias showing a patchy, multifocal distribution.After a mean of 11 weeks(range 1 to 10 months),the patients developed moderate or severe sensorimotor asymmetric neuropathy. Extraneurologic CMV infection occurred in 10 patients before diagnosis. Electrophysiologic studies showed axonal neuropathy and CMV DNA was present in CSF by the polymerase chain reaction(PCR)technique in 90%of patients tested.Fourteen patients showed a marked improvement 1 to 4 weeks after starting ganciclovir or foscarnet therapy.During followup on maintenance therapy(13 patients),the neuropathy relapsed in three patients and probable or confirmed CMV encephalitis occurred in five.Twelve patients died during followup at a mean interval of 9.5 months after their first symptoms.These results extend the clinical spectrum of CMV-MN and show that PCR detection of CMV DNA in CSF may be a useful diagnostic marker. |
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acquired immunodeficiency syndrome
cytomegalovirus infection
human immunodeficiency virus type 1
nerve biopsy
neuropathy
neuropathy,multifocal
neuropathy,painful
neuropathy,peripheral,treatment
polymerase chain reaction
prognosis
treatment of neurologic disorder
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