Opsoclonus-myoclonus syndrome associated with cytomegalovirus encephalitis.

A 30-year-old man was admitted because of febrile respiratory infection and confusion. A lumbar puncture revealed mild pleocytosis and elevated protein. Continuous conjugate eye oscillations in horizontal, rotatory, and vertical direction and diffuse myoclonus were observed (figure; see video on the Neurology Web site at www.neurology.org). Cytomegalovirus (CMV) encephalitis was diagnosed on the basis of positive PCR and high IgG titers in the CSF and rising serum IgM and IgG titers. Brain MRI and HIV serology were negative. The patient was treated with ganciclovir, steroids, and immunoglobulins with remarkable recovery. The opsoclonus-myoclonus syndrome (OMS) is caused by infections and neoplasms.1,2 CMV infection should be considered in OMS cases.