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High-dose corticosteroids for acute cytomegalovirus-associated transverse myelitis in the immunocompetent patient: a case report and systematic review

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Abstract

We present an immunocompetent patient with transverse myelitis (TM) during acute cytomegalovirus (CMV) infection, as evidenced by a reactive serum CMV IgM and CMV viremia. The patient had an excellent outcome after receiving only high-dose methylprednisolone. Given concerns that practitioners may have around the use of immunosuppressive therapy for this potentially infectious myelopathy, we systematically reviewed the literature to assess outcomes after administration of high-dose corticosteroids to this population. Despite severe disease at clinical nadir with inability to ambulate, immunocompetent patients with acute CMV-associated TM who received high-dose corticosteroids had good clinical outcomes 1 month to 1 year after presentation.

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References

  • Arslan F, Yilmaz M, Paksoy Y, Karag E, Mert A (2015) Cytomegalovirus-associated transverse myelitis: a review of nine well-documented cases. Infect Dis 47(1):7–12

    Article  Google Scholar 

  • Daida K, Ishiguro Y, Eguchi H, Machida Y, Hattori N, Miwa H (2016) Cytomegalovirus-associated encephalomyelitis in an immunocompetent adult: a two-stage attack of direct viral and delayed immune-mediated invasions. case report BMC Neurol 16(1):223

    Article  Google Scholar 

  • Davies NWS, Brown LJ, Gonde J, Irish D, Robinson RO, Swan AV et al (2005) Factors influencing PCR detection of viruses in cerebrospinal fluid of patients with suspected CNS infections. J Neurol Neurosurg Psychiatry 76(1):82–87

    Article  CAS  Google Scholar 

  • De Fino C, Nociti V, Modoni A, Bizzarro A, Mirabella M (2016) An atypical case of acute disseminated encephalomyelitis associated with cytomegalovirus infection. Mult Scler Relat Disord 5:70–72

    Article  Google Scholar 

  • de Seze J, Lanctin C, Lebrun C, Malikova I, Papeix C, Wiertlewski S, Pelletier J, Gout O, Clerc C, Moreau C, Defer G, Edan G, Dubas F, Vermersch P (2005) Idiopathic acute transverse myelitis: application of the recent diagnostic criteria. Neurology 65(12):1950–1953

    Article  Google Scholar 

  • Fux CA, Pfister S, Nohl F, Zimmerli S (2003) Cytomegalovirus-associated acute transverse myelitis in immunocompetent adults. Clin Microbiol Infect 9(12):1187–1190

    Article  CAS  Google Scholar 

  • Hooi WF, Malhotra A, Pollard J (2018) Cytomegalovirus associated longitudinally extensive transverse myelitis and acute hepatitis in an immunocompetent adult. J Clin Neurosci 50:152–154

    Article  Google Scholar 

  • Kalita J, Misra UK (2001) Is methyl prednisolone useful in acute transverse myelitis? Spinal Cord 39(9):471–476

    Article  CAS  Google Scholar 

  • Karacostas D, Christodoulou C, Drevelengas A, Paschalidou M, Ioannides P, Constantinou A, Milonas I (2002) Cytomegalovirus-associated transverse myelitis in a non-immunocompromised patient. Spinal Cord 40(3):145–149

    Article  CAS  Google Scholar 

  • Karunarathne S, Govindapala D, Udayakumara Y, Fernando H (2012) Cytomegalovirus associated transverse myelitis in an immunocompetent host with DNA detection in cerebrospinal fluid; a case report. BMC Res Notes 5(1):364

    Article  Google Scholar 

  • Kestenbaum M, Auriel EE, Perloock H, Karni A (2015) Suspected CMV associated myelitis in immunocompetent adult without supporting PCR from the CSF. Austin J Clin Neurol 2(5):1042

    Google Scholar 

  • Mahieux F, Gray F, Fenelon G, Gherardi R, Adams D, Guillard A, Poirier J (1989) Acute myeloradiculitis due to cytomegalovirus as the initial manifestation of AIDS. J Neurol Neurosurg Psychiatry 52:270–274

    Article  CAS  Google Scholar 

  • Miles C, Hoffman W, Lai CW, Freeman JW (1993) Cytomegalovirus-associated transverse myelitis. Neurology 43(10):2143–2145

    Article  CAS  Google Scholar 

  • Scott TF, Frohman EM, De Seze J, Gronseth GS, Weinshenker BG, Therapeutics and Technology Assessment Subcommittee of American Academy of Neurology (2011) Evidence-based guideline: clinical evaluation and treatment of transverse myelitis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 77(24):2128–2134

    Article  CAS  Google Scholar 

  • Transverse Myelitis Consortium Working Group (2002) Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 59(4):499–505

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Clinical Neurological Sciences, Division of Neurology, University Hospital, Western University, 339 Windermere Rd, London, ON, N6A 5A5, Canada

    A. Budhram, M. Krawczyk, T. L. H. Chan, J. G. Burneo & C. Shoesmith

  2. Department of Medicine, Division of General Internal Medicine, Western University, London, Ontario, N6A 5A5, Canada

    Y. Liu

  3. Department of Medicine, Division of Infectious Diseases, Western University, London, Ontario, N6A 5A5, Canada

    S. M. Hosseini-Moghaddam

Authors
  1. A. Budhram
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  2. Y. Liu
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  3. M. Krawczyk
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  4. T. L. H. Chan
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  5. J. G. Burneo
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  6. S. M. Hosseini-Moghaddam
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  7. C. Shoesmith
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Correspondence to A. Budhram.

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Budhram, A., Liu, Y., Krawczyk, M. et al. High-dose corticosteroids for acute cytomegalovirus-associated transverse myelitis in the immunocompetent patient: a case report and systematic review. J. Neurovirol. 25, 405–409 (2019). https://doi.org/10.1007/s13365-018-0717-2

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  • DOI: https://doi.org/10.1007/s13365-018-0717-2

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