RELEVANCE OF CLINICAL AND LABORATORY FINDINGS IN THE DIAGNOSIS OF CYTOMEGALOVIRUS ENCEPHALITIS IN PATIENTS WITH AIDS

A retrospective evaluation was conducted in patients with AIDS and an autopsy diagnosis of cytomegalovirus (CMV) encephalitis to determine t he relevance of clinical and laboratory findings in establishing a dia gnosis. On autopsy of 100 patients, CMV encephalitis was diagnosed in 13 patients; eight had periventricular CMV encephalitis, four micronod ular CMV encephalitis, and one both conditions. Seven patients had had a CMV infection previously (6 cases of retinitis, 1 case of colitis), and at the onset of encephalitis all of them were receiving a mainten ance dose of ganciclovir. Examination of the CSF showed specific chang es in patients with periventricular encephalitis. CT revealed no chara cteristic findings, while MRI showed an increased signal intensity on T2 weighted images, CMV DNA amplification by nested PCR was performed in nine patients with CMV encephalitis; PCR was positive in eight pati ents whose CSF was collected during CMV encephalitis, and negative in one patient whose CSF was collected six months before death, In conclu sion, some clinical findings suggest a presumptive diagnosis, especial ly of periventricular encephalitis, and nested PCR appears to be are l iable and rapid technique for making an antemortem diagnosis.