ACUTE POLYRADICULOPATHIES IN HIV-INFECTED PATIENTS

We studied 17 consecutive cases of acute polyradiculopathy (PR) diagno sed in HIV-infected patients to investigate the possible causes of thi s syndrome in our milieu. Sixteen patients presented with lumbosacral PR and one patient had predominantly cervical PR. Electrophysiological study showed a predominantly motor axonal neuropathy in all patients examined. Six patients had a laboratory-confirmed aetiology for the PR : cytomegalovirus (CMV) was isolated from cerebrospinal fluid (CSF) in three cases, meningeal lymphomatosis was diagnosed by CSF cytology in two cases, and one patient had cryptococcal meningitis. Another patie nt was thought to have acute axonal polyradiculoneuritis associated wi th HIV infection. CMV and Mycobacterium tuberculosis were the probable agents in four and three patients, respectively. Finally, in three pa tients a cause could not be established. Both ganciclovir and foscarne t were effective in the treatment of definite or probable CMV PR. The present study confirms that acute lumbosacral PR in HIV-infected patie nts must be considered a syndrome with different causes. CMV and M. tu berculosis infections were the most frequent causative agents in our s eries (41% and 18% of the cases, respectively). Early empirical therap y is often necessary as definite diagnosis may be delayed or never ach ieved. Our experience suggests that, at least in our milieu, anti-tube rculous drugs should be considered in some cases together with gancicl ovir or foscarnet in the empirical therapy for PR in HIV-infected pati ents.