CYTOMEGALOVIRUS VENTRICULOENCEPHALITIS IN AIDS PATIENTS

We report 4 autopsy-proven cases of cytomegalovirus ventriculoencephal itis (CMV-VE) and a further case with dramatic clinical and radiologic al response to ganciclovir therapy, The diagnoses were based upon clin ical features, cerebrospinal fluid (CSF) examination and either brain computerized tomography (CT) or magnetic resonance imaging (MRT), and confirmed by autopsy findings in 4 cases. All patients had previously had an AIDS-defining condition. CMV retinitis was diagnosed in 3 patie nts, 2 of them before the onset of encephalitis. CMV viremia was prese nt in 4 patients. Examination of CSF demonstrated elevated protein and hypoglycorachia in all cases. CSF culture was negative for CMV in 3 o f 3 patients, Periventricular enhancement was detected by MRI in 2 of 3 patients, but in only 1 of 5 patients by CT, Three patients received ganciclovir and 2 patients foscarnet therapy, All 4 patients died. Pa thologic examination revealed periventriculitis with ependymal necrosi s and CMV intranuclear inclusion bodies all 4 patients. One showed a m arked neurological improvement and radiological resolution by MRI afte r 4 weeks of ganciclovir therapy. We conclude that CMV-VE should be su spected in HIV-infected patients who present with altered neurological status, CMV viremia or retinitis, hypoglycorachia and ventriculitis a s demonstrated by MRI. Although more effective therapy is needed, ganc iclovir may be beneficial, as shown in one of our patients.