The most sensitive techniques including PCR are required to rule out specific treatable infections. MRI or myelogram are useful to exclude cauda equina or spinal cord compressive lesions resulting from lymphoma, syphilis or toxoplasmosis. Necrosis of nerve roots and endo- and epineurial blood vessels, marked inflammation, most pronounced in the lumbar region, CMV detection by culture or PCR, cytoplasmic and nuclear CMV inclusions in Schwann cells and fibroblasts. CMV polyradiculopathy requires different treatment than similar syndromes caused by lymphoma or other infections. Inhibit DNA synthesis and viral replication by competing with deoxyguanosine triphosphate for viral DNA polymerase.
Prompt initiation is essential.
This synthetic guanine derivative is an acyclic nucleoside analog of 2'-deoxyguanosine that inhibits viral replication in vitro and in vivo. Patients who show poor clinical response or have persistent viral excretion may be developing resistance. Individualize dosing based on renal function. Coordinate care with the primary care physician and an infectious disease specialist. Delay in diagnosis and treatment can lead to death.