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Cytomegalovirus-related transverse myelitis in an immunocompetent host: a subacute onset of an immune-mediated disease?
  1. Xavier Merchan-del Hierro1,
  2. Alexandra Halalau2
  1. 1 Department of Neurology, Hospital Jose Carrasco Artega, Cuenca, Azuay, Ecuador
  2. 2 Internal Medicine Department, Beaumont Hospital, Royal Oak, Michigan, USA
  1. Correspondence to Dr Alexandra Halalau, alexandra.halalau{at}


We report a case of transverse myelitis in an immunocompetent host with an atypical long onset of symptoms. A 56-year-old man was admitted to the hospital reporting 5 months of progressive ascending lower extremity weakness and numbness, inability to walk, bowel incontinence,urinary retention and several episodes of nausea and vomiting. MRI showed moderate spinal swelling and multiple hyperintense signal changes on cervical levels C2–C5 and thoracic levels T1–T3. Cerebrospinal fluid (CSF) showed pleocytosis and was positive for anti-cytomegalovirus (CMV) IgG intrathecal antibodies, but the CSF PCR for CMV was negative. The diagnosis of immune-mediated CMV-related transverse myelitis was established and the patient was treated with methylprednisolone and valgancyclovir. The patient had poor recovery and remained paraplegic at discharge.

  • drugs: infectious diseases
  • infection (neurology)
  • neuroimaging
  • spinal cord
  • neurology (drugs and medicines)

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  • Contributors All authors: certify that they have participated sufficiently in the work to take public responsibility for the content. XM: took care of the patient while in the hospital and drafted the case report. AH provided extensive intellectual feedback for the case report draft. XM and AH: conducted independent literature search and individually reviewed and summarised the entire referenced literature.

  • Disclaimer Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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