Abstract

CMV infections leads to variable clinical conditions in patients with normal immun system and immunodeficiency. The ratio of symptomatic infection in patients with normal immunodeficiency is under 10%.

Symptomatic patients generally present with momonucleosis like syndrome and rarely with organ specific complications including central nervous system, respiratory system, gastrointestinal system, cardiovascular system, hepatic and hematologic system.

Central nervous system infections of CMV are more common in patients with immunodeficiency and include encephalitis, ventriculoencephalitis, cerebral mass lesions, transverse myelitis and polyradiculomyelitis. Here we present a previously healthy 4 year old boy with CMV infection related diffuse encephalomyelitis due to rare occurrence.

A four year old boy was admitted with complaints of progressive weakness in lower extremities, decreased level of consciousness, irritability, urinary retention and constipation. Muscle power was decreased in proximal and distal muscles of legs and deep tendon reflexes could not be obtained in lower extremities. Anti CMV IgM and IgG were positive and CMV avidity was grey zone. CSF analysis revealed negative CMV, HSV1-2 DNA. Brain and spinal cord MRI revealed hyper intense lesions. Gancyclovir and immunoglobulin treatments were started. Pulse methylprednisolone was then added to treatment. The patient was taken into physical rehabilitation for weakness and intermittent catheterization was ordered for neurogenic bladder.

In conclusion, CMV is a cause of diffuse encephalomyelitis in children with normal immune system, the diagnosis is difficult and depends on serologic, virologic, radiologic and clinical findings. More information is needed for the best treatment protocol of CMV related neurologic disorders in patients with normal immune system.