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 (27; 10). 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; 38; 13), and gastroparesis (54). Cytomegalovirus is one of the primary opportunistic pathogens in late stages of AIDS and affects multiple organs (40). 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.