10/21/2008 Case 3: CMV radiculopathy/multiple cranial neuritis/ventriculo-encephalitis/retinitis, and HIV encephalitis

Presented by: Dr. Ehud Lavi - New York Presbyterian Hospital

Clinical History:

A 36-year-old man with decreased visual acuity, back pain, bilateral radicular pain, fever of 102°F, and known positive for HN. He was dysarthric and dysphagic, he had acute and chronic retinitis, and multiple cranial nerves showed clinical involvement. Gait was unsteady. Radiology revealed signal intensities around the 4th ventricle and multiple thickened cranial nerves. He died of aspiration during a procedure to investigate dysphagia. Autopsy showed the thickened cranial nerves, which were sectioned individually. The characteristic inclusions of cytomegalovirus were found in the cranial nerves and in periventricular regions. Findings of HN encephalitis were also present.

Diagnostic Notes:

CMV radiculopathy, CMV multiple cranial neuritis, CMV ventriculo-encephalitis, HN encephalitis, and CMV retinitis.

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