351. It Is Not Always Tuberculosis: Cytomegalovirus Polyradiculopathy and Encephalitis in Two Filipino Men With Advanced HIV Infection

Background Polyradiculopathy (PRP) and encephalitis are neurologic syndromes associated with 1% of cytomegalovirus (CMV) disease among patients with advanced HIV infection. Untreated patients die within 8 weeks. This case series and literature review highlights the clinical and laboratory features integral to the prompt diagnosis and treatment of these rare but serious manifestations of CMV disease among AIDS patients. Methods We document CMV PRP and encephalitis in two HIV-seropositive men seen in a tertiary hospital in the Philippines. Both patients presented with bilateral leg weakness, paresthesias, hyporeflexia, and urinary retention associated with confusion and memory lapses. In the two cases described, diagnosis of CMV disease was delayed because it was not immediately entertained. Tuberculosis involving the nervous system was first ruled out. Results The first case was a 31-year-old male with a baseline CD4 count of 9 cells/mm3 who presented with signs and symptoms of bilateral leg weakness and paresthesias 3 weeks after initiation of antiretrovirals (ART). CMV viremia was detected by PCR. Ganciclovir was initiated late, and he subsequently died of multiorgan failure. The second case is a 29-year-old male with a baseline CD4 count of 2 cells/mm3. CMV DNA PCR was detected in the CSF. He died prior to initiation of anti-CMV therapy. Conclusion CMV-related neurologic complications are uncommon, but often fatal when appropriate anti-CMV therapy is not initiated promptly. The diagnosis of CMV PRP should be considered in patients with advanced immunosuppression presenting with ascending paraplegia, areflexia, and urinary retention with typical CSF abnormalities (polymorphonuclear pleocytosis, elevated protein concentration, and hypoglycorrhachia). Table 1. Summary of Presenting Signs and Symptoms of the Two Cases in Comparison to the 103 Patients with CMV PRP in Anders and Goebel’s Review Sign or Symptom Anders and Goebel [2] Case 1 Case 2 Lower limb weakness 100% Present Present Lower limb areflexia 100% Present Present Urinary retention 94% Present Present Paresthesia 79% Present Present Sensory loss (legs) 72% Present Present Fecal incontinence 67% Absent Absent Lumbar pain 36% Absent Absent Babinski sign 16% Absent Absent Disclosures All authors: No reported disclosures.