Flaccid quadriplegia in an AIDS patient

Abstract

A 29 years old heterosexual caucasian male, former intravenous drug users, HIV 1+, with AIDS diagnosed 10 months before (pulmonary tu­berculosis - CDC C3) was admited in our ward for the first time in November 93 with a volunta­ry intoxication with isoniazid (13,5 gr) and ri­fampin (27 gr). He was treated with high doses of pyridoxine (5 gr) without any immediate com­plications.

One month later an ascending progressive flac­cid quadriplegia requiring mechanical ventilation was developed in four days. He had fever, menin­geal irritation signs, no cognitive impairment and sensory anaesthesia below T4 leveL CSF showed pleocytosis with predominant polymorphonuclear leukocytes, elevated protein, and IgA intrathecal syntesis. The immunological serum and CSF exami­ nation gave no evidence of recent infection with herpes vírus, Toxoplasma gondii or Cryptococcus neoformans direct and cultural CSF examination revealed no acid-fast bacilli.

The CT scan revealed cervical spinal cordenlar­ gement with partial subarachnoidal space oblite­ration at C3 level. The somatosensory evoked res­ponses suggested spinal cord blocking. The elec­tromyography revealed a peripheral polyneuropa­thy with a demyelinating component.

The patient was initially treated with gancyclovir without clinical improvement and, in face of the results mentioned above, corticoid therapy was ins­tituted.

Four months later there was a partial recovery ( upper limbs muscular strenght grade 3, lower limbs grade 1, autonomous breathing and TIO sensory level). At this time, repeated immunological serum examination revealed IgM positive for CMV in two determinations.

The authors admit, on the basis of the clinicai and CSF pathern, a cytomegalovirus radiculomyelopa­thy with associated peripheral polyneuropathy in the context of advanced stage HIV injection ( AIDS CDCC3).