CYTOMEGALOVIRUS MULTIFOCAL NEUROPATHY IN AIDS - ANALYSIS OF 15 CONSECUTIVE CASES

A severe multifocal neuropathy caused by cytomegalovirus (CMV-MN) can occur in the late stage of human immunodeficiency virus (HIV) infectio n. In a retrospective study, we identified 15 consecutive HIV-positive patients with a diagnosis of CMV-MN based on (1) markedly asymmetric neuropathy, (2) fewer than 100 CD4(+) cells per mm(3), (3) exclusion o f other causes of neuropathy, and (4) characteristic CMV cytopathic ch anges on neuromuscular biopsy (2 patients), positive CSF culture for C MV (2 patients), or clinical improvement on anti-CMV therapy given for concurrent extraneurologic CMV disease (8 patients) or neuropathy (3 patients). All patients were men and had severe immunosuppression (mea n CD4(+) cell count, 18 per mm(3)). The initial symptoms were numbness and painful paresthesias showing a patchy, multifocal distribution. A fter a mean of 11 weeks (range, 1 to 10 months), the patients develope d moderate or severe sensorimotor asymmetric neuropathy. Extraneurolog ic CMV infection occurred in 10 patients before diagnosis. Electrophys iologic studies showed axonal neuropathy and CMV DNA was present in CS F by the polymerase chain reaction (PCR) technique in 90% of patients tested. Fourteen patients showed a marked improvement I to 4 weeks aft er starting ganciclovir or foscarnet therapy. During follow-up on main tenance therapy (13 patients), the neuropathy relapsed in three patien ts and probable or confirmed CMV encephalitis occurred in five. Twelve patients died during follow-up, at a mean interval of 9.5 months afte r their first symptoms. These results extend the clinical spectrum of CMV-MN and show that PCR detection of CMV DNA in CSF may be a useful d iagnostic marker.