UPDATE Cytomegalovirus-associated acute transverse myelitis in immunocompetent adults C. A. Fux 1 , S. P®ster 1 , F. Nohl 2 and S. Zimmerli 1 1 Institute for Infectious Diseases, University of Bern, and 2 Emergency and Trauma Department, University Hospital of Bern, Bern, Switzerland We report a case of transverse myelitis as a complication of acute cytomegalovirus (CMV) infection in immunocompetent patients; and review the literature on the entity. Primary CMV infection was documented by CMV antigenemia and high serum titers of CMV IgM and IgG antibodies. Cerebrospinal ¯uid (CSF) pleocytosis indicated central nervous system in¯ammation; CSF polymerase chain reaction (PCR) for CMV, however, was negative. The results of magnetic resonance imaging of the myelon were normal. Although CMV-associated transverse myelitis has been well described in HIV-positive individuals, but is very rare in immunocompetent individuals. It remains unclear whether the neuronal damage is immune mediated or due to a cytotoxic effect of viral infection. The outcome is mainly favorable. Keywords Cytomegalovirus, transversemyelitis, immunocompetent Accepted 16 May 2003 Clin Microbiol Infect 2003; 9: 1187±1190 INTRODUCTION Acute transverse myelitis (ATM) is an uncommon syndrome characterized by segmental motor, sen- sory and autonomic dysfunction of the spinal cord [1,2]. Larger retrospective series have revealed an incidence of 1.3±4.6 cases per million per year [1,3]. The disease usually begins with back pain, and this is followed by the onset of acute or subacute paraparesis, an ascending sensory level, and dis- turbed sphincter functions. Approximately 50% of patients temporarily lose all movement in their legs, 80±94% have paresthesias, and almost all have bladder dysfunction [4]. Possible causes include (para)infectious or post-vaccinial states, multiple sclerosis, or autoimmune disorders. Mechanical myelon compression, metastasis and vascular insuf®ciency must be ruled out in the diagnosis. Cytomegalovirus (CMV) is a common opportu- nistic pathogen in severely immunocompromised patients. It may cause transverse myelitis and other central and peripheral neurologic affections [5]. CMV radiculomyelitis was found in 3.4% of autopsies of patients with AIDS [6]. In contrast, CMV-induced myelitis is very rare in immuno- competent patients. We report on a healthy man developing trans- verse myelitis as a complication of acute CMV infection. CASE REPORT A 31-year-old man was admitted to our hospital because of progressive proximal leg weakness and a sensory level ascending to T6. The neurologic symptoms had begun 4 days earlier, with numb- ness in the feet. The patient had suffered from a high fever, intermittent chills and a dry cough for 2 weeks before admission. On examination, we found hypesthesia below T12 and hyperesthesia/paresthesia between T12 and T6. Proximal muscle strength in the legs was M2 on the left and M3 on the right. Muscle strength below the knee was M3 on the left and M4 on the ß 2003 Copyright by the European Society of Clinical Microbiology and Infectious Diseases Corresponding author and reprint requests: S. Zimmerli, Institute for Infectious Diseases, University of Bern, Fried- buehlstrasse 51, PO Box 61, CH-3010 Bern, Switzerland Tel: 41 31 632 32 58 Fax: 41 31 632 35 50 E-mail: [email protected]
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