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Washington University Experience | PERIPHERAL NEUROPATHY | 10 INFECTION | 2 Cytomegalovirus (in AIDS) | 2A0 Case 2 History
Case 2 History ---- This 43 year old man with advanced HIV expired at home shortly following discharge from Jewish Hospital for terminal care. His HIV course had been complicated by advanced CMV retinitis and cryptococcal meningitis for several years. The cryptococcal meningitis had responded well to therapy and he was on maintenance itraconazole. He had been admitted to Jewish Hospital for weakness. Hypophonia was noted and ENT examination revealed bilateral vocal cord paralysis that required tracheostomy. Neurologic examination showed bilateral abducens nerve palsies and a right facial paralysis with a lower motor neuron pattern suggesting involvement of multiple cranial nerves. Neither hemiparesis nor meningeal signs were noted. Spinal fluid analysis on two occasions revealed greater than 1000 WBC/mm3 with approximately 80% PMN's, glucose of 30, and minimally elevated protein. MRI of the head showed minimal atrophy but no brainstem pathology or meningeal enhancement. A few budding yeasts were seen in the CSF but cryptococcal antigen was not significantly elevated. PCR for CMV was positive. The patient was treated with amphotericin and induction therapy for CMV but failed to respond. Given his poor neurological condition and underlying illness, he was discharged home and expired shortly thereafter.
