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Combined therapy with ganciclovir and foscarnet for CMV polyradiculomyelitis.
Karmochkine M; Lesprit P; Coutellier A; Scieux C; Welker Y; Cherin P;
December 30, 1994
Int Conf AIDS. 1994 Aug 7-12;10(2):127 (abstract no. PB0520). Unique

OBJECTIVE: To evaluate the efficacy of a dual anti-cytomegalovirus (CMV) therapy in 3 cases of CMV polyradiculomyelitis. PATIENTS AND METHODS: Three men with AIDS, presented with progressive paraparesis in their lower limbs, together with a cauda equine syndrome. Two were previously treated for CMV retinitis: Pt 2 has been treated with Foscarnet for one year, and Pt 3 with Ganciclovir for 6 months. Cerebrospinal fluid (CSF) contained polymorphonuclear leukocytes, hyperproteinorachia and normal or low glycorrhachia. CMV was detected in blood and CSF using culture and PCR, confirming the diagnosis. The 3 patients were treated with combined therapy with full dose Foscarnet and Ganciclovir, instituted 2 weeks after the initial symptoms. RESULTS: 1/Neurological status dramatically improved (i.e. able to walk) after 3 weeks of treatment. 2/CSF was cleared in blood and CSF in all cases after 3 weeks, as shown in the Table:. TABULAR DATA, SEE ABSTRACT VOLUME. 3/Renal insufficiency was observed in one patient during the fourth week, leading to reduce the dose of Foscarnet; neutropenia in another, leading to institute granulocyte colony stimulating factor. DISCUSSION AND CONCLUSIONS: After early recognition of CMV polyradiculomyelitis, a combination of antiviral regimen appears as an attractive therapy. It is not ascertained that improvement is due to the early institution of the treatment and/or to the dual anti-CMV regimen.

AIDS-Related Opportunistic Infections/COMPLICATIONS/*DRUG THERAPY/ MICROBIOLOGY Case Report Cerebrospinal Fluid/MICROBIOLOGY Cytomegalovirus/ISOLATION & PURIF Cytomegalovirus Infections/COMPLICATIONS/*DRUG THERAPY/ MICROBIOLOGY Drug Therapy, Combination Foscarnet/*ADMINISTRATION & DOSAGE/ADVERSE EFFECTS Ganciclovir/*ADMINISTRATION & DOSAGE Human Kidney Failure/CHEMICALLY INDUCED Male Myelitis/COMPLICATIONS/*DRUG THERAPY/MICROBIOLOGY Neutropenia/CHEMICALLY INDUCED Polyradiculitis/COMPLICATIONS/*DRUG THERAPY/MICROBIOLOGY Viremia/COMPLICATIONS/DRUG THERAPY ABSTRACT

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