       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).

