RESUMEN
Leg pain and weakness can often be seen in a musculoskeletal physiotherapy outpatient setting. While the differential diagnoses for neuropathic pain and weakness is often spine related, this unusual cause for polyradiculopathy is less commonly seen. Shingles is not something routinely seen in a physiotherapy department but is usually associated with skin eruptions and pain but less so with motor loss. The purpose of this case report is to therefore raise awareness that this presentation can occur and should not be mistaken for spinal radiculopathy.
Asunto(s)
Herpes Zóster/complicaciones , Herpesvirus Humano 3 , Neuropatías Peroneas/virología , Polirradiculopatía/virología , Herpes Zóster/virología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Primary Human herpesvirus-7 (HHV-7) infection usually occurs during childhood and causes several clinical manifestations: mainly exanthem subitum (roseola infantum), followed by a lifelong latent state with possible reactivation in case of immunodeficiency. Nevertheless, some considerably different approaches exist regarding the natural history of HHV-7 and the possible consequences of HHV-7 infection in immunocompetent adults. In particular, little is known about its pathogenic role in central nervous system (CNS) disease in nonimmunosuppressed adults. Specifically, in case of encephalitis, it is important to distinguish between infectious encephalitis and postinfectious encephalomyelitis for the management of patients CASE PRESENTATION: We describe here a case of encephalitis associated to human herpesvirus-7 with associated polymyeloradiculopathy in an immunocompetent patient which may contribute to the delineation of the approach to a patient profile with a similar clinical presentation and evolution to those presented in the literature. CONCLUSIONS: This case may alert clinicians to consider this specific etiology in the differential diagnosis of encephalopathy in patients with suspected infectious encephalitis who do not respond to acyclovir or in patients who develop acute polymyeloradiculopathy, considering that HHV-7 may be a pathological factor and that a timely diagnosis is crucial for the early administration of specific treatment.
Asunto(s)
Encefalitis Viral/diagnóstico , Encefalitis Viral/patología , Herpesvirus Humano 7/aislamiento & purificación , Infecciones por Roseolovirus/diagnóstico , Infecciones por Roseolovirus/patología , Adulto , Encefalitis Viral/complicaciones , Encefalitis Viral/virología , Humanos , Masculino , Polirradiculopatía/diagnóstico , Polirradiculopatía/patología , Polirradiculopatía/virología , Infecciones por Roseolovirus/virologíaRESUMEN
Polyradiculopathy (PRP) is a rare but serious neurologic complication of cytomegalovirus (CMV) in patients with acquired immunodeficiency syndrome (AIDS). We herein report three cases of CMV PRP in patients with AIDS. Although providing a prompt diagnosis and initiating anti-CMV therapy may achieve clinical improvements, administering single-drug treatment may result in virologic failure. Therefore, introducing antiretroviral therapy is a key step for improving the treatment outcomes of CMV PRP.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Infecciones por Citomegalovirus/etiología , Polirradiculopatía/etiología , Adulto , Antivirales/uso terapéutico , Pueblo Asiatico , Líquido Cefalorraquídeo/virología , Infecciones por Citomegalovirus/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Polirradiculopatía/tratamiento farmacológico , Polirradiculopatía/virologíaRESUMEN
In the era of high-dose chemotherapy and novel antimyeloma agents, the survival of multiple myeloma (MM) patients has substantially improved. Adverse effects, including infections, may however arise in the era of combination antimyeloma therapies. In general, MM patients have shown a risk of varicella zoster virus (VZV) infection of 1-4 %, increasing with bortezomib treatment or transplants, but whether immunomodulatory drugs also bear a risk of VZV/complicated herpes simplex virus (HSV) (e.g., VZV-encephalitis [VZV-E], disseminated VZV-infection [d-VZV-i], or conus-cauda syndrome [CCS]) has not been elucidated. We here assessed VZV, VZV-E, d-VZV-i, and CCS in 93 lenalidomide-treated MM patients, consecutively seen and treated in our department. Patients' data were analyzed via electronic medical record retrieval within our research data warehouse as described previously. Of the 93 MM patients receiving lenalidomide, 10 showed VZV or other complicated VZV/HSV infections. These VZV patients showed defined risk factors as meticulously assessed, including suppressed lymphocyte subsets, substantial cell-mediated immune defects, and compromised humoral immune response. Due to our findings-and in line with an aciclovir prophylaxis in bortezomib and stem cell transplant protocols-we introduced a routine aciclovir prophylaxis in our lenalidomide protocols in May 2012 to minimize adverse events and to avoid discontinuation of lenalidomide treatment. Since then, we have observed no case of VZV/complicated HSV infection. Based on our data, we encourage other centers to also focus on these observations, assess viral infections, and-in those centers facilitating a research data warehouse-advocate an analogue data review as an appropriate multicenter approach.
Asunto(s)
Profilaxis Antibiótica , Encefalitis por Varicela Zóster/prevención & control , Herpes Simple/prevención & control , Herpes Zóster/prevención & control , Mieloma Múltiple/tratamiento farmacológico , Talidomida/análogos & derivados , Aciclovir/uso terapéutico , Anciano , Anciano de 80 o más Años , Inhibidores de la Angiogénesis/uso terapéutico , Antivirales/uso terapéutico , Encefalitis por Varicela Zóster/complicaciones , Encefalitis por Varicela Zóster/epidemiología , Encefalitis por Varicela Zóster/virología , Femenino , Alemania/epidemiología , Herpes Simple/complicaciones , Herpes Simple/epidemiología , Herpes Simple/virología , Herpes Zóster/complicaciones , Herpes Zóster/epidemiología , Herpes Zóster/virología , Herpesvirus Humano 3/efectos de los fármacos , Herpesvirus Humano 3/inmunología , Herpesvirus Humano 3/aislamiento & purificación , Humanos , Huésped Inmunocomprometido/efectos de los fármacos , Incidencia , Lenalidomida , Masculino , Persona de Mediana Edad , Mieloma Múltiple/complicaciones , Mieloma Múltiple/inmunología , Mieloma Múltiple/virología , Polirradiculopatía/complicaciones , Polirradiculopatía/epidemiología , Polirradiculopatía/prevención & control , Polirradiculopatía/virología , Factores de Riesgo , Simplexvirus/efectos de los fármacos , Simplexvirus/inmunología , Simplexvirus/aislamiento & purificación , Talidomida/efectos adversos , Talidomida/uso terapéuticoRESUMEN
BACKGROUND: Nervous system complications of primary Epstein-Barr virus (EBV) infection in adults are rare, but may occur with encephalitis, meningitis, myelitis, cranial and peripheral neuropathies, or radiculitis. CASE PRESENTATION: We describe an immune competent adult with a primary EBV infection complicated by lumbosacral polyradiculitis with pure radicular pain. Prior to the onset of radicular pain the 35-year-old woman had been suffering from infectious mononucleosis misdiagnosed for streptococcal tonsillitis. The diagnosis of primary EBV infection associated polyradiculitis was proven by serology and PCR in serum and CSF. Under initially started empiric therapy with intravenous acyclovir and analgesics the patient completely recovered within a few days. CONCLUSION: This case report highlights that EBV should be taken into consideration in the diagnostic work up of radicular pain syndromes, even in immune competent adults. There is no approved causal therapy for EBV infections. In accordance with our case, observations based on a few patients with EBV and nervous system involvement suggest, that acyclovir treatment might be associated a with better course. However, prospective randomized controlled trials addressing the question of the effectiveness of acyclovir in patients with primary EBV infection and neurological complications are lacking.
Asunto(s)
Infecciones por Virus de Epstein-Barr/complicaciones , Polirradiculopatía/etiología , Polirradiculopatía/virología , Adulto , Femenino , HumanosRESUMEN
Although cytomegalovirus (CMV) disease in CMV IgM/IgG-negative renal transplant recipients from CMV-positive donors (D+/R-) can occur after discontinuation of prophylaxis treatment as a flu-like syndrome or tissue invasive disease, involvement of the central nervous system is rare. Here, we report a case of CMV polyradiculopathy 6 months after renal transplantation that presented as a Guillain-Barre like syndrome and was successfully treated with foscarnet. This case highlights an uncommon aspect of CMV invasive disease which we should keep in mind in CMV (D+/R-) renal transplant recipients.
Asunto(s)
Infecciones por Citomegalovirus/complicaciones , Trasplante de Riñón/efectos adversos , Polirradiculopatía/virología , Adulto , Antivirales/uso terapéutico , Infecciones por Citomegalovirus/tratamiento farmacológico , Foscarnet/uso terapéutico , Ganciclovir/análogos & derivados , Ganciclovir/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Polirradiculopatía/diagnóstico , Factores de Tiempo , ValganciclovirAsunto(s)
Polirradiculopatía/diagnóstico , Fiebre del Nilo Occidental/diagnóstico , Virus del Nilo Occidental/aislamiento & purificación , Femenino , Humanos , Persona de Mediana Edad , Polirradiculopatía/complicaciones , Polirradiculopatía/patología , Polirradiculopatía/virología , Pronóstico , Fiebre del Nilo Occidental/complicaciones , Fiebre del Nilo Occidental/patología , Fiebre del Nilo Occidental/virologíaAsunto(s)
Enfermedad de Crohn/tratamiento farmacológico , Herpes Zóster/virología , Herpesvirus Humano 3 , Inmunosupresores/efectos adversos , Mercaptopurina/efectos adversos , Aciclovir/uso terapéutico , Antivirales/uso terapéutico , Enfermedad de Crohn/complicaciones , Herpes Zóster/líquido cefalorraquídeo , Herpes Zóster/tratamiento farmacológico , Humanos , Inmunosupresores/uso terapéutico , Masculino , Meningitis Viral/virología , Mercaptopurina/uso terapéutico , Persona de Mediana Edad , Polirradiculopatía/virologíaAsunto(s)
Rodilla , Debilidad Muscular/diagnóstico , Debilidad Muscular/fisiopatología , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Debilidad Muscular/virología , Polirradiculopatía/complicaciones , Polirradiculopatía/diagnóstico , Polirradiculopatía/virología , Médula Espinal/patología , Médula Espinal/virologíaRESUMEN
Characteristic symptoms of acute polyradiculitis are parestesia beginning from the feet and a symmetrically ascending myasthenia. The symptomatology, which may vary from mild asthenia to complete tetraplegia, may be accompanied by asphyxia and symptoms of the autonomic nervous system and cranial nerves. Polyradiculitis is often preceded by an infection. An elevated protein level of the cerebrospinal fluid without cellular reaction is the typical finding, but a specific laboratory test is not available. The clinical course is monophasic and relapses are uncommon. The natural prognosis for recovery is fairly good, but one fifth are left with functional impairment and the disease may even be fatal.
Asunto(s)
Polirradiculopatía/líquido cefalorraquídeo , Polirradiculopatía/complicaciones , Diagnóstico Diferencial , Humanos , Polirradiculopatía/virología , Pronóstico , RecurrenciaAsunto(s)
Virus de la Encefalitis Transmitidos por Garrapatas/patogenicidad , Encefalitis Transmitida por Garrapatas/complicaciones , Polirradiculopatía/etiología , Polirradiculopatía/virología , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Médula Espinal/patología , Médula Espinal/virologíaRESUMEN
Cytomegalovirus lumbosacral polyradiculopathy is a well-documented complication of human immunodeficiency virus in adults who have a CD4 count of less than 40/microL. Patients present with an acute ascending flaccid paralysis of the lower limbs with areflexia, paresthesia, and urinary and bowel symptoms. However, it appears to be rare in children with congenitally acquired immune deficiency syndrome. We report a 9-year-old child with congenital human immunodeficiency virus infection who presented with cytomegalovirus polyradiculopathy and made an excellent response to cytomegalovirus treatment.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Antivirales/uso terapéutico , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por VIH/congénito , Polirradiculopatía/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/patología , Encéfalo/patología , Niño , Infecciones por Citomegalovirus/patología , Quimioterapia Combinada , Femenino , Foscarnet/uso terapéutico , Ganciclovir/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Polirradiculopatía/patología , Polirradiculopatía/virología , Columna Vertebral/patología , Resultado del TratamientoAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Infecciones por Citomegalovirus/tratamiento farmacológico , Citosina/análogos & derivados , Organofosfonatos/uso terapéutico , Polirradiculopatía/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Adulto , Cidofovir , Infecciones por Citomegalovirus/complicaciones , Citosina/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Polirradiculopatía/virologíaRESUMEN
Co-infection with HIV and hepatitis C has become increasingly prevalent. It is a major source of morbidity in HIV-infected populations. Distal symmetric polyneuropathy is the most common form of peripheral neuropathy in HIV as well as hepatitis C mono-infection. There is considerable overlap in the symptoms and signs of HIV and hepatitis C neuropathy. It is not known whether there are additive or synergistic effects on the peripheral nerve by these two viruses. There is a need for studies to further elucidate the mechanisms involved.
Asunto(s)
Infecciones por VIH/complicaciones , Hepatitis C/complicaciones , Enfermedades del Sistema Nervioso Periférico/virología , Síndrome de Guillain-Barré/virología , Humanos , Mononeuropatías/virología , Polirradiculopatía/virologíaRESUMEN
A 55-year-old man with acute myeloid leukemia in second relapse presented 4 months after haploidentical CD34+-selected hematopoietic stem cell transplantation (HSCT) with symmetric, progressive neurological deficits of the lower extremities. Although there was no molecular evidence for drug resistance in the cerebral-spinal fluid, antiviral combination therapy failed to control the rapidly progressing CMV polyradiculopathy (PRP) and encephalitis, which were confirmed by autopsy studies. Late CMV PRP as an unusual manifestation of CMV disease should be kept in mind in patients with suggestive neurological symptoms after HSCT.
Asunto(s)
Infecciones por Citomegalovirus/complicaciones , Trasplante de Células Madre Hematopoyéticas , Leucemia Mieloide/terapia , Polirradiculopatía/virología , Enfermedad Aguda , Antígenos CD34/metabolismo , Infecciones por Citomegalovirus/patología , Resultado Fatal , Haploidia , Células Madre Hematopoyéticas/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Polirradiculopatía/patologíaRESUMEN
PURPOSE: To report bilateral corneal endotheliitis caused by a vesicular virus (family Rhabdoviridae). METHODS: Case report of a 49-year-old man with a complaint of sudden onset of decreased vision in both eyes had diffuse corneal stromal edema with extensive folds in Descemet's membrane and was diagnosed as having bilateral viral endotheliitis. Virologic investigations were performed using aqueous humor from the right eye. RESULTS: An ether- and chloroform-sensitive cytopathic agent was isolated in Vero and BHK-21 cell lines from the aqueous humor. It was identified as a vesicular virus belonging to the family Rhabdoviridae by electron microscopy. Neutralizing antibody was demonstrated at a titer greater than 1 in 4,096 dilutions in the convalescent serum. Neurologic complications included loss of hearing and postinfectious polyradiculopathy affecting both lower limbs. Best-corrected visual acuity was 20/120 OD and 20/20 OS. Six months later, he developed glaucoma in the right eye. Trabeculectomy with intraoperative application of 5-fluorouracil was performed. CONCLUSION: This is the first report of bilateral endotheliitis caused by a vesicular virus and confirmed by virus isolation from the aqueous humor of the affected eye.
Asunto(s)
Humor Acuoso/virología , Enfermedades de la Córnea/virología , Endotelio Corneal/virología , Infecciones Virales del Ojo/virología , Infecciones por Rhabdoviridae/virología , Vesiculovirus/aislamiento & purificación , Enfermedades de la Córnea/patología , Endotelio Corneal/patología , Infecciones Virales del Ojo/patología , Pérdida Auditiva Sensorineural/patología , Pérdida Auditiva Sensorineural/virología , Humanos , Masculino , Persona de Mediana Edad , Polirradiculopatía/patología , Polirradiculopatía/virología , Infecciones por Rhabdoviridae/patología , Vesiculovirus/ultraestructura , Cultivo de Virus , Agudeza VisualRESUMEN
We report two male patients with AIDS, aged 23 and 30 years old respectively. One was admitted due to a progressive weakness of the left leg and urinary and fecal incontinence. The other was admitted due to a progressive paraparesia without incontinence, but with a severe lumbar pain. In both patients polymerase chain reactions for cytomegalovirus in cerebrospinal fluid were positive. Treatment with ganciclovir, for 21 and 14 days respectively and highly active antiretroviral therapy was started. Both patients experienced recovery of their neurological deficits after 98 and 88 days of therapy, respectively.