CASE-OF-THE-MONTH - MAY 1998 - A PATIENT WITH HIV-INFECTION AND MULTIPLE CRANIAL NEURITIS - CMV VENTRICULO-ENCEPHALITIS, POLYRADICULITIS AND MULTIPLE CRANIAL NEURITIS

A 36-year old male with a three year history of HIV infection and more recently, CMV retinitis, had several episodes of polyradiculitis with severe bilateral leg pain and urinary retention which resolved slowly over several months. He then presented with high fevers and severe dy sphagia with dehydration, Examination showed oral thrush, dyarthric sp eech and mild memory impairment. Fundoscopic exam showed CMV retinitis and HIV retinopathy, Further examination revealed other cranial nerve signs and leg weakness. MRI scans showed several contrast enhancing a bnormalities of cranial nerve roots. The patient died from massive bar ium aspiration, At autopsy the brain showed multiple CMV cranial neuri tis, CMV polyradiculitis and CMV ventriculoependymitis, While spinal n erve root involvement by CMV may occur in up to 1% of AIDS patients, i nvolvement of cranial nerves is unusual and CMV infection of multiple cranial nerves is distinctly rare.