Neuropathies associated with cytomegalovirus infection

Pavan Tummala MD MS (Dr. Tummala of Saint Louis University has no relevant financial relationships to disclose.)
Niranjan N Singh MD (Dr. Singh of the University of Missouri - Columbia has no relevant financial relationships to disclose.)
Florian P Thomas MD MA PhD MS (Dr. Thomas, Chair, Department of Neurology, Seton Hall-Hackensack Meridian School of Medicine, has no relevant financial relationships to disclose.)
Louis H Weimer MD, editor. (Dr. Weimer of Columbia University has received consulting fees from Roche.)
Originally released January 5, 1995; last updated September 12, 2017; expires September 12, 2020

Overview

Cytomegalovirus is the most common cause of polyradiculopathy in AIDS. It occurs in about 2% of HIV-infected patients referred to neurologists. Expeditious diagnosis is crucial, as this disease may progress rapidly to death, but does respond to antiviral therapy when started early. The authors provide an overview of neuropathies associated with cytomegalovirus infection.

Historical note and terminology

Prior to the AIDS epidemic, cytomegalovirus was rarely associated with peripheral neuropathies, but was recognized as an antecedent infection associated with Guillain-Barré syndrome (Klemola et al 1967; Dowling and Cook 1981). Since the first AIDS cases were identified in the United States in 1981, several discrete neuropathic syndromes have been linked to cytomegalovirus, including lumbar radiculopathy, distal symmetrical polyneuropathy, mononeuritis multiplex (Behar and McCutchan 1987; Robert et al 1989; Fuller 1992), and gastroparesis (Thongpooswan et al 2015). Cytomegalovirus is one of the primary opportunistic pathogens in late stages of AIDS and affects multiple organs (Roullet et al 1994). Retinitis is the most common manifestation, affecting 10% to 20% of patients, but esophagitis, gastritis, colitis, pneumonitis, myelitis, encephalitis, and optic neuropathy also occur. Physicians should have a low threshold for entertaining this diagnosis, as many patients improve significantly with antiviral treatment.

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