Moulignier A, Mikol J, Gonzalez-Canali G, Wallays C, Thiebaut JB, Dupont B; International Conference on AIDS.
Int Conf AIDS. 1994 Aug 7-12; 10: 197 (abstract no. PB0216).
Hopitaux Tenon, Paris, France.
Cytomegalovirus (CMV) induced myelitis is a rare but known complication in AIDS. Presenting with rapidly progressive paraparesis, sensory loss and urine retention, the disease has not been described to our knowledge, as an intramedullary spinal cord tumor. A 33-year-old homosexual man, CDC stage IVC2 (CD4 = 20/mm3) presented with a rapidly worsening paraplegia, urine retention and bowel dysfunction. Magnetic resonnance imaging (MRI) of the spinal cord showed a swollen conus medullaris and, after infusion of gadolinium, an intensely enhancing lesion raising the hypothesis of a tumor. Cerebrospinal fluid (CSF) examination revealed 120 white blood cells/microliter (85% polynuclear neutrophils), 560 mg/dl protein. Polymerase chain reaction (PCR) of CMV was positive in blood and CSF. Open surgical biopsy of the lesion with laminectomy was performed a few days after the onset of the neurological features. Histological examination confirmed CMV infection and PCR on the biopsy was also positive for the CMV. The patient dramatically improved with Foscarnet (he was able to walk) and the lesion of the conus medullaris shown on MRI completely resolved within one month. Despite Foscarnet for 4 months, neurological symptoms reappeared. A new MRI showed the reapparition of the same previous lesion. No response was obtained with Gancyclovir and the patient died 6 months after the onset of the first symptoms. Although it is unlikely that an enhancing spinal cord lesion will be specific for a certain etiology, CMV should be in the differential diagnosis.
Publication Types:
Keywords:
- Cytomegalovirus Infections
- Diagnosis, Differential
- Humans
- Laminectomy
- Magnetic Resonance Imaging
- Male
- Myelitis
- Neoplasm Staging
- Paraplegia
- Spinal Cord Diseases
- Spinal Cord Neoplasms
- surgery
Other ID:
UI: 102208490
From Meeting Abstracts