The University of Toledo Translation Journal of Medical Sciences 
Infectious Diseases Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

CMV transverse myelitis in Unmanaged 
HIV Infection 
Victoria Starnes, M31*, Victoria Soewarna, M31, Caitlyn Hollingshead, MD1, Joel Kammeyer, MD1 
1Division of Infectious Diseases, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 

*Corresponding author: Victoria.starnes@rockets.utoledo.edu

Published: 05 May 2023 

Introduction: Acute transverse myelitis (ATM) is an inflammatory spinal cord injury that may be an 
isolated process or caused by a secondary disease (1). Symptoms include lower limb weakness, urinary 
incontinence, numbness, or paresthesia. Prior to the availability of antiretroviral therapy (ART), ATM 
was seen in patients with primary HIV infection due to opportunistic infections (2). We present a case of 
ATM attributed to cytomegalovirus secondary to uncontrolled HIV.    

Case Presentation: A 33-year-old HIV-positive male presented with lower extremity weakness and 
bipedal paresthesia. He had been diagnosed with HIV in 2017 but had never initiated ART due to 
financial constraints. His initial CD4 count was 7 cells/mm3 and his viral load was 208,000 copies/mL. 
A viral meningitis panel detected herpes simplex virus 1 (HSV-1), cytomegalovirus (CMV), and 
varicella zoster virus (VZV). A cytomegalovirus DNA quantitative PCR revealed 6,381,260 IU/mL.   
Treatment was initiated with valganciclovir 900 mg oral twice daily for 14 days for induction therapy, 
bictegravir-emtricitabine-tenofovir alafenamide one tablet daily, and sulfamethoxazole-trimethoprim one 
tablet oral daily. His weakness and strength improved. Unfortunately, this patient was subsequently lost 
to follow up and the outcome is unknown.   

Discussion: With developments in management of HIV with ART, opportunistic infections are seen less 
often. Our patient underscores that advanced presentations can still occur and are often secondary to 
gaps in education and accessibility. This case highlights the necessity for comprehensive patient 
education and the importance of adhering to ART regimens to maintain a high CD4+ count and prevent 
progression of the disease. 

https://dx.doi.org/10.46570/utjms.vol11-2023-760 

https://dx.doi.org/10.46570/utjms.vol11-2023-760
mailto:Victoria.starnes@rockets.utoledo.edu