Polyradiculopathy and Gastroparesis due to Cytomegalovirus Infection in AIDS: A Case Report and Review of Literature

Abstract

Patient: Female, 46Final Diagnosis: CMV gastroparesis and radiculopathySymptoms: Nausea • paraplegia • urinary retention • vomitingMedication: —Clinical Procedure: Lumbar punctureSpecialty: Infectious DiseasesObjective:Unusual clinical courseBackground: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.

Elsberg Syndrome Secondary to Cytomegalovirus Infection in an Immunocompetent Patient

“…In CMV polyradiculopathies, positive CSF PCR for CMV was found mostly in immunosuppressed patients with AIDS. 2 , 3 , 4 …”

“… 5 The pathogenesis of peripheral neuropathy after CMV infection remains unclear, in particular whether it is due to a direct toxic effect of the viral infection or due to autoimmunity triggered by molecular mimicry. 3 …”

“…5 The pathogenesis of peripheral neuropathy after CMV infection remains unclear, in particular whether it is due to a direct toxic effect of the viral infection or due to autoimmunity triggered by molecular mimicry. 3 To the contrary, CMV can cause various severe manifestations in immunocompromised patients through either primary CMV infection or reactivation of latent CMV infection. 5 Indeed, in immunocompromised patients, encephalitis, myeloradiculopathy, polyradiculopathy, and polyneuropathy secondary to CMV infection are classically reported.…”

Cytomegalovirus lumbosacral polyradiculitis in patients with long-term use of an oral corticosteroid: a case report

“…Ganciclovir is the first-line of treatment for CMV polyradiculitis. Acyclovir is not used in treating CMV polyradiculitis due to inferior response compared with Ganciclovir [ 14 ]. After finishing treatment with Ganciclovir (when CMV PCR in the CSF analysis is negative), Valacyclovir can be applied to prevent recurrence [ 14 ].…”

Diabetic and Non-Diabetic Gastroparesis: A Retrospective Comparative Outcome Study From the Nationwide Inpatient Sample

“…PVGP is often self-limiting with excellent prognosis and gradually improves over 1 year [ 21 , 25 ]. However, persistent symptoms may be seen in CMV, EBV or VZV infections secondary to severe dysautonomia [ 24 , 26 ].…”