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Cytomegalovirus and herpes simplex virus ascending myelitis in a patient with acquired immune deficiency syndrome
Author(s) -
Tucker Tarvez,
Dix Richard D.,
Katzen Carolyn,
Davis Richard L.,
Schmidley James W.
Publication year - 1985
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.410180113
Subject(s) - myelitis , cytomegalovirus , pathology , herpes simplex virus , medicine , immunology , encephalitis , herpesviridae , virus , virology , spinal cord , biology , viral disease , psychiatry
Progressive ascending myelitis was the presenting feature of the acquired immune deficiency syndrome (AIDS) in a homosexual man who also had Kaposi's sarcoma, Pneumocystis pneumonia, and disseminated cytomegalovirus (CMV) infection. Neuropathological studies showed profuse cytomegalic cells throughout the brain and spinal cord, but no inflammatory response. At postmortem examination, CMV and herpes simplex virus, type 2 (HSV‐2), were recovered from multiple sites throughout the central nervous system (CNS). HSV‐2 was isolated from the anus, but from no other extraneural site; in contrast, pathology typical of CMV was also seen in the liver, gastrointestinal tract, adrenals, and lungs. Although histopathological evidence suggesting prior CMV infection has been seen in the brains of AIDS patients, the virus has never been cultured from the CNS in these immunosuppressed hosts, nor has it been known to infect the spinal cord. The absence of an inflammatory response suggests that the pathogenesis of CNS viral infections is altered in AIDS patients. Evidence for CMV infection of the CNS in AIDS patients is no longer circumstantial.