CMV neurologic disease
Background
Clinical Features[1]
- Typically presents in immunocompromised hosts (e.g. AIDS) with history of prior CMV illness (e.g. CMV retinitis
- Usually encephalitis, presenting as a acute, rapid onset, progressive encephalopathy but can also manifest as polyradiculitis
- Encephalitis:
- Memory impairment with dementia-like presentation
- Motor deficits, numbness, cranial nerve palsies
- Ataxia, nystagmus
- Mass lesion with focal deficits or evidence of mass effect
- +/- Fever
- Polyradiculitis
- Back pain/sciatica
- Paresthesia, distal sensory loss
- Urinary retention
- Ascending paralysis, similar to Guillain-Barre
Differential Diagnosis
Altered mental status and fever
- Infectious
- Sepsis
- Meningitis
- Encephalitis
- Cerebral malaria
- Brain abscess
- Other
HIV associated conditions
- HIV neurologic complications
- HIV pulmonary complications
- Ophthalmologic complications
- Other
- HAART medication side effects[2]
- HAART-induced lactic acidosis
- Neuropyschiatric effects
- Hepatic toxicity
- Renal toxicity
- Steven-Johnson's
- Cytopenias
- GI symptoms
- Endocrine abnormalities
Evaluation
Management
Antivirals
- Ganciclovir 5mg/kg IV q12hrs daily x 21 days FOLLOWED BY 5mg/kg IV q24hrs +
- Foscarnet 90mg/kg IV q12hrs x 21 days THEN 90-120mg/kg IV q24hrs
Disposition
- Admit
See Also
External Links
References
- ↑ https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545043/all/CMV__neurologic
- ↑ Gutteridge, David L MD, MPH, Egan, Daniel J. MD. The HIV-Infected Adult Patient in The Emergency Department: The Changing Landscape of the Disease. Emergency Medicine Practice: An Evidence-Based Approach to Emergency Medicine. Vol 18, Num 2. Feb 2016.