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Question Date: 30/06/2023

Question: 33-year-old woman with a history of uncontrolled HIV infection developed pain and weakness in both legs that progressed over severa months, and she has had urinary retention for the past week. Electrodiagnostic studies are consistent with lumbosacral polyradiculopathy. Lumbosacral MRI shows thickening and enhancement of the lumbosacral nerve roots at multiple levels. Lumbar puncture reveals neutrophilic pleocytosis. This syndrome is most likely due to infection by which of the following infectious agents?

Options:

• Cryptococcus neoformans
• Cytomegalovirus
• Herpes simplex virus type 1
• Mycobacterium avium-intracellulare complex

Correct Answer: Cytomegalovirus

Explaination: Cytomegalovirus is the typical cause of a lumbosacral polyradiculopathy in the severely immune compromised, and unlike most viral infections, it is associated with neutrophilic pleocytosis. Patients with HIV are also at risk for CNS infection with the other infectious agents listed, but those agents usually are not associated with lumbosacral polyradiculopathy or neutrophilic pleocytosis.

Reference: Page 111,Lyons JL. Myelopathy associated with microorganisms. Continuum (Minneap Minn). 2015 Feb;21(1 Spinal Cord Disorders):100-20. doi: 10.1212/01.CON.0000461087.56371.e8. Erratum in: Continuum (Minneap Minn). 2015 Jun;21(3 Behavioral Neurology and Neuropsychiatry):590. PMID: 25651220.