CMV neurologic disease: Difference between revisions
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==Background== | ==Background== | ||
==Clinical Features== | ==Clinical Features<ref>https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545043/all/CMV__neurologic</ref>== | ||
*Typically presents in immunocompromised hosts (e.g. [[AIDS]]) with history of prior CMV illness (e.g. [[CMV retinitis]] | *Typically presents in immunocompromised hosts (e.g. [[AIDS]]) with history of prior CMV illness (e.g. [[CMV retinitis]] | ||
*Usually [[encephalitis]], presenting as a acute, rapid onset, progressive [[encephalopathy]] but can also manifest as polyradiculitis | *Usually [[encephalitis]], presenting as a acute, rapid onset, progressive [[encephalopathy]] but can also manifest as polyradiculitis | ||
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**[[Paresthesia]], distal [[numbness|sensory loss]] | **[[Paresthesia]], distal [[numbness|sensory loss]] | ||
**[[Urinary retention]] | **[[Urinary retention]] | ||
**Ascending [[weakness|paralysis]], similar to [[ | **Ascending [[weakness|paralysis]], similar to [[Guillain-Barre]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Latest revision as of 00:35, 3 October 2019
Background
Clinical Features[1]
- Typically presents in immunocompromised hosts (e.g. AIDS) with history of prior CMV illness (e.g. CMV retinitis
- Usually encephalitis, presenting as a acute, rapid onset, progressive encephalopathy but can also manifest as polyradiculitis
- Encephalitis:
- Memory impairment with dementia-like presentation
- Motor deficits, numbness, cranial nerve palsies
- Ataxia, nystagmus
- Mass lesion with focal deficits or evidence of mass effect
- +/- Fever
- Polyradiculitis
- Back pain/sciatica
- Paresthesia, distal sensory loss
- Urinary retention
- Ascending paralysis, similar to Guillain-Barre
Differential Diagnosis
Altered mental status and fever
- Infectious
- Sepsis
- Meningitis
- Encephalitis
- Cerebral malaria
- Brain abscess
- Other
HIV associated conditions
- HIV neurologic complications
- HIV pulmonary complications
- Ophthalmologic complications
- Other
- HAART medication side effects[2]
- HAART-induced lactic acidosis
- Neuropyschiatric effects
- Hepatic toxicity
- Renal toxicity
- Steven-Johnson's
- Cytopenias
- GI symptoms
- Endocrine abnormalities
Evaluation
Management
Antivirals
- Ganciclovir 5mg/kg IV q12hrs x 21 days then 5mg/kg IV q24hrs +
- Foscarnet 90mg/kg IV q12hrs x 21 days then 90-120mg/kg IV q24hrs
Disposition
- Admit
See Also
External Links
References
- ↑ https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545043/all/CMV__neurologic
- ↑ Gutteridge, David L MD, MPH, Egan, Daniel J. MD. The HIV-Infected Adult Patient in The Emergency Department: The Changing Landscape of the Disease. Emergency Medicine Practice: An Evidence-Based Approach to Emergency Medicine. Vol 18, Num 2. Feb 2016.