AIDS-ASSOCIATED CYTOMEGALOVIRUS-INFECTION MIMICKING CENTRAL-NERVOUS-SYSTEM TUMORS - A DIAGNOSTIC CHALLENGE

We reviewed cases of cytomegalovirus (CMV) infection of the central ne rvous system (CNS) that initially masqueraded as tumors in 37 of 543 c onsecutive patients infected with human immunodeficiency virus (HIV) a nd CMV who were seen at the Pasteur Institute Hospital and Saint-Louis Hospital (Paris) between 1992 and 1994. We detail the clinical featur es of three patients who presented with ring-enhanced space-occupying lesions mimicking CNS tumors. They were all profoundly immunodepressed (mean CD4 cell count, 13/mm(3)). Magnetic resonance imaging (MRI) sho wed enlargement of the spinal cord in one case, consistent with a spac e-occupying lesion and showing gadolinium enhancement; in the other tw o cases, ring-enhanced mass lesions were seen in the cerebral hemisphe res. In all three cases marked edema and a mass effect were present. I mage-guided stereotactic biopsies confirmed the diagnosis of CMV infec tion. The three patients' conditions improved with specific therapy. M RI showed enhanced focal intraparenchymal lesions consistent with mark ed focal necrosis, probably related to the severity of immunodepressio n, as HIV infection had been diagnosed several years previously. CMV i nfection should be considered as a cause of ring-enhanced space-occupy ing mass lesions in patients with HIV-1 infection. Earlier identificat ion of these unusual tumorlike forms of CMV infection by means of MRT should result in improved outcome.