POLYRADICULOPATHY DUE TO CYTOMEGALOVIRUS - REPORT OF 2 CASES IN WHICHIMPROVEMENT OCCURRED AFTER PROLONGED THERAPY AND REVIEW OF THE LITERATURE

Neurological syndromes attributed to cytomegalovirus (CMV) in patients infected with human immunodeficiency virus (HIV) include encephalitis , myelitis, and peripheral neuropathy. More recently, polyradiculopath y due to CMV has been described. We review the literature and describe two patients with CMV polyradiculopathy whose conditions improved onl y after prolonged therapy with ganciclovir. Patients typically are you ng men who are severely immunocompromised and have had other opportuni stic infections. The syndrome is characterized by subacute onset of le g weakness and numbness progressing to paraparesis or paraplegia. Blad der dysfunction is common. In many patients, CMV may be identified els ewhere; concomitant retinitis is common and often subclinical. Laborat ory studies commonly show an increased number of neutrophils in CSF an d hypoglycorrhachia. Electromyography and nerve conduction studies sup port the diagnosis. Imaging studies may be most useful to exclude spin al lesions. Without treatment prognosis is poor. Survival time is impr oved and symptoms often abate, sometimes dramatically, with ganciclovi r therapy. Improvement of conditions may be rapid but can take months, as illustrated by these two cases. Once initiated, ganciclovir should be administered indefinitely to patients with CMV polyradiculopathy.