Cytomegalovirus associated transverse myelitis in an immunocompetent host with DNA detection in cerebrospinal fluid; a case report.
Cytomegalovirus associated transverse myelitis in an immunocompetent host with DNA detection in cerebrospinal fluid; a case report.
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DOI：
10.1186/1756-0500-5-364
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发表时间：
2012-07-20
影响因子：
1.8
通讯作者：
Fernando, Harshini
中科院分区：
文献类型：
--
作者：
Karunarathne, Suneth;Govindapala, Dumitha;Fernando, Harshini
背景：免疫功能正常的成人中巨细胞病毒相关的横肌炎很少报道。我们报告一个病人提出临床myeloma其次是以前未报告的发现巨细胞病毒脱氧核糖核酸在脑脊液。病例报告：一个四十岁的免疫功能正常的男性急性发作进行性双侧下肢无力。他的脊髓磁共振成像结果、脑脊液分析和临床表现与横肌萎缩一致。脑脊液巨细胞病毒聚合酶链反应阳性，而其他感染因子未被血清学或聚合酶链反应检测到。他接受了静脉注射更昔洛韦治疗，取得了部分临床反应。结论：对脊髓液中的病毒基因组进行了检测，但在报告的免疫活性宿主巨细胞病毒相关横贯性脊髓炎病例中，有五例为阴性。在以前的病例中，无法在脑脊液中分离出病毒被认为有利于导致发病的免疫机制，而不是直接的病毒毒性，但该病例与该理论相反。此病例强调巨细胞病毒应被视为横肌萎缩症患者的病原体，并且该病毒可能在免疫活性宿主中引起严重感染。因此，这份报告是重要的神经学家和医生一般。
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.