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1994-10-25
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Document 2911
DOCN M94A2911
TI Cytomegalovirus myelitis mimicking intramedullary spinal cord tumor.
DT 9412
AU Moulignier A; Mikol J; Gonzalez-Canali G; Wallays C; Thiebaut JB; Dupont
B; Hopitaux Tenon, Paris, France.
SO Int Conf AIDS. 1994 Aug 7-12;10(1):197 (abstract no. PB0216). Unique
Identifier : AIDSLINE ICA10/94369664
AB Cytomegalovirus (CMV) induced myelitis is a rare but known complication
in AIDS. Presenting with rapidly progressive paraparesis, sensory loss
and urine retention, the disease has not been described to our
knowledge, as an intramedullary spinal cord tumor. A 33-year-old
homosexual man, CDC stage IVC2 (CD4 = 20/mm3) presented with a rapidly
worsening paraplegia, urine retention and bowel dysfunction. Magnetic
resonnance imaging (MRI) of the spinal cord showed a swollen conus
medullaris and, after infusion of gadolinium, an intensely enhancing
lesion raising the hypothesis of a tumor. Cerebrospinal fluid (CSF)
examination revealed 120 white blood cells/microliter (85% polynuclear
neutrophils), 560 mg/dl protein. Polymerase chain reaction (PCR) of CMV
was positive in blood and CSF. Open surgical biopsy of the lesion with
laminectomy was performed a few days after the onset of the neurological
features. Histological examination confirmed CMV infection and PCR on
the biopsy was also positive for the CMV. The patient dramatically
improved with Foscarnet (he was able to walk) and the lesion of the
conus medullaris shown on MRI completely resolved within one month.
Despite Foscarnet for 4 months, neurological symptoms reappeared. A new
MRI showed the reapparition of the same previous lesion. No response was
obtained with Gancyclovir and the patient died 6 months after the onset
of the first symptoms. Although it is unlikely that an enhancing spinal
cord lesion will be specific for a certain etiology, CMV should be in
the differential diagnosis.
DE Adult AIDS-Related Opportunistic Infections/DIAGNOSIS/DRUG THERAPY/
*MICROBIOLOGY Case Report Cytomegalovirus/ISOLATION & PURIF
Cytomegalovirus Infections/COMPLICATIONS/DIAGNOSIS/DRUG THERAPY/
*MICROBIOLOGY Diagnosis, Differential Fatal Outcome
Foscarnet/THERAPEUTIC USE Human Magnetic Resonance Imaging Male
Myelitis/COMPLICATIONS/DIAGNOSIS/DRUG THERAPY/*MICROBIOLOGY
Paraplegia/*ETIOLOGY Recurrence Spinal Cord Neoplasms/*DIAGNOSIS
Urination Disorders/*ETIOLOGY MEETING ABSTRACT
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).