Six
AIDS patients with progressive cytomegalovirus (CMV) polyradiculomyelitis were treated with
ganciclovir in an open study. The diagnosis was based on the presence of a distinct clinical syndrome with progressive flaccid
paraparesis, preserved proprioception and
urinary retention with specific cerebrospinal fluid (CSF) findings.
Ganciclovir therapy, 5-10 mg/kg per day, instituted 3-6.5 weeks after onset of symptoms, was ineffective in four patients with severe
paraparesis. One patient developed CMV polyradiculomyelitis while receiving
ganciclovir and further deteriorated during
foscarnet therapy. One patient however, showing minor
paresis of one leg, improved after institution of
ganciclovir therapy 1 week after onset of symptoms. It is concluded that a presumptive diagnosis of CMV polyradiculomyelitis can be made on the basis of distinct clinical findings and CSF
pleocytosis with predominance of polymorphonuclear leukocytes in patients with
AIDS.
Ganciclovir therapy does not appear to be beneficial for patients with advanced
paresis in the doses used. Further investigations are needed in order to determine if early intervention with
ganciclovir, when
paresis is mild, or higher doses in advanced
paresis, might be of some benefit.