Cytomegalovirus polyradiculopathy in HIV-infected patients

Cytomegalovirus polyradiculopathy, a late complication of HIV infection, is characterized by lower extremity weakness, urinary retention, and sacral dysesthesias. We describe four patients (mean CD4 T-cell count=25 cells/mm³) who developed this “infectious cauda equina syndrome.” The characteristic cerebrospinal fluid (CSF) findings, notably atypical for a viral infection, included polymorphonuclear leukocytosis (mean white blood cell count=1512 cells/mm³, 72% polymorphonuclear leukocytes), elevated protein level (mean=370 mg/dl), and hypoglycorrhacia (mean=28 mg/dl). Physicians who treat patients with HIV should be familiar with this syndrome because early intervention, prior to microbiologic confirmation, provides the best hope for improving neurologic function. Presented at a meeting of the American Society of Microbiology, Atlanta, GA, May 1993. The views expressed in this article are those of the authors and do not reflect the official policy of the U.S. Department of Defense or other departments of the United States Government.