CMV neuropathy is typically the result of opportunistic infection in an immunocompromised host, commonly presenting in an acute or subacute fashion. CMV-associated neuropathy may present as a mononeuropathy multiplex, but more commonly presents as a rapidly progressive symmetric polyneuropathy or polyradiculoneuropathy. The patient presented was seronegative for HIV by history, and there was no evidence of a significantly immunocompromised state from the examinations performed. The motor weakness is symmetric, most commonly affecting distal muscles and ascending rapidly to the trunk and upper extremities. Autonomic involvement may also occur, with labile blood pressure, and cardiac dysrhythmias.
Diagnosis is based upon electrodiagnostic and CSF analysis.
Electrodiagnostic studies typically reveal demyelinating neuropathy, with frequent conduction abnormalities attributable to nerve root compromise. CSF examination reveals elevated protein levels with normal white blood cell counts. This patient did present with acute and rapid onset of weakness in his extremities, together with erectile dysfunction suggestive of autonomic involvement. He also experienced gastrointestinal symptoms prior to the onset of his weakness. Drug-induced neuropathies are typically axonal in presentation.