Cytomegalovirus-associated transverse myelitis in a non-immunocompromised patient

Abstract

Design: Single case report. Objective: To report a rare case of cytomegalovirus (CMV)-associated transverse myelitis (TM) in the immunocompetent host. Settings: Collaboration between a Neurology and Radiology University Department in Greece and a Molecular Virology Department in Cyprus. Patient: A 16-year-old male student developed an acute febrile illness followed shortly by TM, that resulted in paraplegia over 24 h. Rapid clinical improvement was followed by complete recovery in 2 months. Extensive laboratory work-up excluded other possible causes of TM and showed no evidence of an immunocompromised state. Antiviral serological data, identi®cation of the viral genome by polymerase chain reaction and serial spinal cord magnetic resonance imaging ®ndings, supported the diagnosis of CMV-associated TM in a nonimmunocompromised patient. Conclusions: Our case further indicates that CMV infection should be included in the di erential diagnosis of TM of uncertain etiology, in the immunocompetent patient. Clinical, immunological and neuroimaging ®ndings indicate that post-infectious immune mediated in¯ammation, seems the most probable pathogenetic mechanism in this case.

Encephalomyelitis following mumps

“…These include herpes simplex virus, Epstein-Barr virus, hepatitis B virus and cytomegalovirus. 2,3 The myelitis syndromes may be subdivided into meningitis with myelitis, meningitis with anterior horn syndrome and myelitis without meningitis. 1 Mumps was seldom reported in association with myelitis.…”

Neuroimaging of infections

“…Cases due to herpesviridae such as Varicella zoster virus, cytomegalovirus, and Epstein-Barr virus (EBV) have frequently been described, often in immunocompromised patients. 30 Because these cases often present with ascending paraparesis, differentiation from inflammatory polyradiculitis is essential to rapidly decide on the necessity of therapy with antiviral agents or high-dose steroids versus intravenous immunoglobulins (IVIG). MRI shows high signal changes in the cord with variable edema and Gd enhancement, additionally in lumbosacral roots in EBV infection.…”

Cytomegalovirus associated transverse myelitis in an immunocompetent host with DNA detection in cerebrospinal fluid; a case report

“…While cytomegalovirus is an identified cause of myelitis in immunocompromised hosts, it is rare in the immunocompetent people with only few published case reports (Table 1). Cytomegalovirus PCR has demonstrated the presence of CMV DNA in blood in only two reported cases of CMV associated transverse myelitis in the immunocompetent patients [7,8]. In other immunocompetent patients with CMV transverse myelitis, either PCR was not done or was negative.…”