Cytomegalovirus and herpes simplex virus ascending myelitis in a patient with acquired immune deficiency syndrome

Abstract

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.

Herpes simplex Virus Myelitis: Clinical Manifestations and Diagnosis by the Polymerase Chain Reaction Method

“…In previous reports, HSV myelitis was accompanied by conditions that reduce immunologic competence, such as acquired immunodeficiency syndrome [5,6], malignancies [7,8], and diabetes mellitus [3]. Ellie et al [12] and Flope et al [13] have recently reported HSV myelitis in nonimmunocompromised patients.…”

Recurrent Myelitis Associated with Herpes Simplex Virus Type 2

“…Other severe neurological complications such as encephalitis, meningitis and lethal panmyelitis, have been described, especially in the immunocompromised host [5][6][7].…”

CMV and HSV-2 myeloradiculitis in an HIV infected patient

“…Since either CMV or HSV-2 can infect multiple cell types (neurons, astrocytes, oligodendrocytes and microglia) in the CNS 3,12 we can speculate on a possible synergistic effect of this concurrent infection in producing spinal cord lesion. To corroborate this hypothesis, we were able to find only three previous reports 8,17,23 in HIV patients. All these patients had profound immunosuppression, and the prognosis was grim in the two patients it was available (death in one and minimal recovery in the other).…”