[A case of acquired immune deficiency syndrome presenting acute lumbosacral polyradiculopathy due to opportunistic infection of cytomegalovirus].

We reported a case of acquired immune deficiency syndrome (AIDS) with acute lumbosacral polyradiculopathy (ALSP), resulting from the opportunistic infection of cytomegalovirus (CMV). A 22-year-old Thai woman noticed weakness of the both legs, and two weeks later, she became unable to walk and had the difficulty of voiding. Neurological examination revealed flaccid paraplegia, sensory disturbance of the both legs, areflexia of the patella and ankle, and urinary retention. She could not move the legs on either side except for ankle flexion or extension, and the passive elevation of the leg brought about severe sacral pain. Radiological examinations, including lumbar MRI, failed to reveal abnormal findings. The needle EMG showed an acute denervation of the lower leg muscles, and the lumbar puncture yielded a colorless fluid containing 2,097/cu mm WBC (polynuclear 88%), 412 mg/dl protein and 45 mg/dl glucose. The serum HIV-1 antibody was positive with a marked loss of CD4 lymphocytes (31/cu mm). In CSF, the DNA of CMV was detected in the polymerase chain reaction (PCR) method. In addition, large round cells with intranuclear or cytoplasmic inclusions showing immunopositivity for the CMV antibody were present. Ganciclovir (daily dose: 400 mg, every 12 h) was administered for two weeks, but the painful numbness gradually extended to the trunk. For AIDS patients, ALSP caused by the CMV infection is a rare neurological complication, and this is the first case report in Japan. Progressive flaccid paraplegia with sensory disturbance, radicular pain, or bladder dysfunction are characteristic symptoms, and CSF pleocytosis with elevated protein or hypoglycorrhachia provides a diagnostic clue for clinicians. In addition, the CMV-DNA amplification in the PCR method or immunohistochemical approach from CSF is a useful procedure.