Encephalomyelitis responsive to ganciclovir.

Department of Neurology and Institute of Radiology, Medical School, University of São Paulo, São Paulo SP, Brazil. A 19-year-old previously healthy boy was admitted with a ten-day history of rapidly progressive urinary retention, constipation, ascending hypoesthesia up to the thoracic level and gait instability. On physical examination, he presented fever, tetraparesis, brisk reflexes, multidirectional nystagmus, right-side Horner’s syndrome. CSF: 225 cells/mm (15% neutrophils), protein 142 mg/dl, glucose 46 mg/dl. MRI: Fig 1. Acute demyelinating encephalomyelitis was diagnosed and the patient was treated with high doses of corticosteroids for five days. Despite CSF improvement after corticosteroid treatment, clear signs of clinical worsening were observed. Anti-CMV (IgG and IgM) antibodies were detected in the CSF, and this justified empirical treatment with ganciclovir, starting one week after the corticosteroids. In one month, the patient was able to stand and walk with canes. MRI showed complete recovery (Fig 2).