PREDOMINANCE OF NEUTROPHILS IN THE CEREBROSPINAL-FLUID OF AIDS PATIENTS WITH CYTOMEGALOVIRUS RADICULOPATHY

Cytomegalovirus (CMV) radiculopathy has been associated with both vira l cytopathic inclusions and an increased number of neutrophils in the cerebrospinal fluid (CSF) of patients with AIDS. The significance of t hese findings is unknown. To evaluate this, the authors reviewed all C SF cytology specimens from patients with a history AIDS or HIV infecti on over a 9-year period. Of 193 specimens identified, 42 (22%) had neu trophils present. Neutrophils were rare (<6 per slide) in the majority of specimens (57%). Occasional neutrophils (<2/hpf) were observed in three patients; one with suspected CMV myelitis, one with bacterial me ningitis, and one with cryptococcal meningitis. All 6 cases (3 patient s) with numerous neutrophils (>10/hpf) had positive CMV CSF cultures a nd symptoms of radiculopathy. Definite viral inclusions were not seen. The prognosis a ss poor in all cases. The authors conclude that diagn ostic CMV inclusions are quite rare. However, the presence of elevated numbers of neutrophils in the CSF of a patient with AIDS without an i dentified infectious agent is highly suggestive of CMV radiculopathy.