Polyradiculopathy and Gastroparesis due to Cytomegalovirus Infection in AIDS: A Case Report and Review of Literature
Unusual clinical course, Challenging differential diagnosis
Supat Thongpooswan, Eric Chyn, Mostafa Alfishawy, Erfidia Restrepo, Charles Berman, Kawser Ahmed, Sethu Muralidharan
(Department of Internal Medicine, Queens Hospital Center/Icahn School of Medicine at Mount Sinai, New York, NY, USA)
Am J Case Rep 2015; 16:801-804
Cytomegalovirus (CMV) infection has been well described as an opportunistic infection of patients with human immunodeficiency virus (HIV). To the best of our knowledge, this is the first case report of a patient with AIDS and lumbosacral polyradiculopathy, associated with gastroparesis resulting from CMV infection.
CASE REPORT: A 46-year-old Hispanic woman with a history of HIV for 10 years was admitted to our hospital for nausea, vomiting, urinary retention, and generalized weakness. Bilateral lower extremity examination revealed flaccid paraplegia, decreased sensations from the groin downwards, bilateral lower extremity areflexia, and absent plantar reflexes, with enlarged urinary bladder. CMV was detected in CSF by PCR, and cervical and lumbar magnetic resonance imaging (MRI) revealed intense nodular leptomeningeal enhancement from the lower thoracic cord and extending along the conus medullaris/filum terminalis and nerve roots. Gastric emptying scintigraphy revealed severe delayed gastric emptying time. Ganciclovir was initiated and her neurological symptoms and gastrological symptoms gradually improved. Over 8 weeks, nausea and vomiting resolved and the patient was able to walk before being discharged from the hospital.
CONCLUSIONS: Polyradiculopathy and gastroparesis can result from CMV infection in AIDS patients. Whether the mechanism is secondary to viral infection or immune systems remains unclear. It is important for physicians to be aware of this uncommon presentation in the antiretroviral therapy (ART) era. CMV treatment should be initiated immediately once diagnosis is confirmed.
Keywords: Acquired Immunodeficiency Syndrome - complications, Cytomegalovirus - genetics, Cytomegalovirus Infections - complications, DNA, Viral - analysis, Diagnosis, Differential, Female, Gastroparesis - etiology, Humans, Magnetic Resonance Imaging, Middle Aged, Polyradiculopathy - etiology, Tomography, X-Ray Computed