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

BMC Research Notes

Harshini Fernando¹  Yapa Udayakumara¹  Dumitha Govindapala¹  Suneth Karunarathne¹ 

[1] National hospital of Sri Lanka, Regent street, Colombo, Sri Lanka

关键词: Hyper intensity;    Polymerase chain reaction;    Cerebrospinal fluid;    Immunocompetent;    Cytomegalovirus;    Transverse myelitis;   

Others  :  1166126
DOI  :  10.1186/1756-0500-5-364

 received in 2012-04-18, accepted in 2012-07-05,  发布年份 2012

【 摘 要 】

Background

Cytomegalovirus associated transverse myelitis among immunocompetent adults has been rarely reported. We report a patient presenting with clinical myelitis followed by previously unreported finding of cytomegalovirus deoxyribonucleic acid in cerebrospinal fluid.

Case report

A forty year old immunocompetent male presented with acute onset progressive bilateral lower limb weakness. His spinal magnetic resonance imaging findings, cerebrospinal fluid analysis and clinical picture were compatible with transverse myelitis. Polymerase chain reaction of the cerebrospinal fluid for cytomegalovirus was positive while other infectious agents were not detected by serology or polymerase chain reaction. He was treated with intravenous ganciclovir with partial clinical response.

Conclusion

Viral genome detection in the cerebrospinal fluid was performed but negative in five out of ten reported cases of cytomegalovirus associated transverse myelitis in the immunocompetent host. In previous cases the inability to isolate the virus in cerebrospinal fluid was considered favouring an immunological mechanism leading to pathogenesis rather than direct viral toxicity but this case is against that theory. This case highlights the fact that Cytomegalovirus should be considered as an aetiological agent in patients with transverse myelitis and that the virus may cause serious infections in immunocompetent host. Therefore this report is of importance to neurologists and physicians in general.

【 授权许可】

   
2012 Karunarathne et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME: Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J 2008, 5:47. BioMed Central Full Text
• [2]Griffiths P: Cytomegalovirus infection of the central nervous system. Herpes 2004, 11(Suppl 2):95A-104A.
• [3]Transverse Myelitis Consortium Working Group: Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 2002, 59:499-505.
• [4]Ben Abdelhafidh N, Battikh R, Laabidi J, M'sadek F, Ajili F, Ben Moussa M, Amor A, Ben Abdallah N, Louzir B, Othmani S: [Cytomegalovirus myelitis in immunocompetent adult]. Rev Med Interne 2006, 27:883-885.
• [5]Rigamonti A, Usai S, Ciusani E, Bussone G: Atypical transverse myelitis due to cytomegalovirus in an immunocompetent patient. Neurol Sci 2005, 26(5):351-354.
• [6]Fux CA, Pfister S, Nohl F, Zimmerli S: Cytomegalovirus-associated acute transverse myelitis in immunocompetent adults. Clin Microbiol Infect 2003, 9:1187-1190.
• [7]Karacostas D, Christodoulou C, Drevelengas A, Paschalidou M, Ioannides P, Constantinou A, Milonas I: Cytomegalovirus-associated transverse myelitis in a non-immunocompromised patient. Spinal Cord 2002, 40:145-149.
• [8]Giobbia M, Carniato A, Scotton PG, Marchiori GC, Vaglia A: Cytomegalovirus-associated transverse myelitis in a non-immunocompromised patient. Infection 1999, 27:228-230.
• [9]Baig SM, Khan MA: Cytomegalovirus-associated transverse myelitis in a non-immunocompromised patient. J Neurol Sci 1995, 134:210-211.
• [10]Miles C, Hoffman W, Lai CW, Freeman JW: Cytomegalovirus-associated transverse myelitis. Neurology 1993, 43(10):2143-2145.
• [11]Tobita M, Komiyama A, Naito M, Johkura K, Hasegawa O: Cytomegalovirus ascending myelitis in an immunocompetent adult. Rinsho Shinkeigaku 1993, 33:915-917.
• [12]Tyler KL, Gross RA, Cascino GD: Unusual viral causes of transverse myelitis: hepatitis A virus and cytomegalovirus. Neurology 1986, 36:855-858.
• [13]Kabins S, Keller R, Naragi S, Peitchel R: Viral ascending radiculomyelitis with severe hypoglycorrhachia. Arch Intern Med 1976, 136:933-935.
• [14]Eddleston M, Peacock S, Juniper M, Warrell DA: Severe Cytomegalovirus Infection in Immunocompetent Patients. Clin Infect Dis 1997, 24:52-56.