B27.11

Clinical Causes: Primary infection with cytomegalovirus, often transmitted through bodily fluids such as saliva, blood, urine, semen, or breast milk. Reactivation of dormant CMV in individuals with compromised immune systems, including those with HIV/AIDS, organ transplant recipients, or individuals undergoing immunosuppressive therapy. Transmission through close contact with infected persons, including during sexual activity or from mother to child during childbirth. Blood transfusions or organ transplants from CMV-infected donors.

Key Symptoms: Fever and fatigue, similar to typical mononucleosis symptoms. Sore throat and swollen lymph nodes. Muscle aches and general discomfort. Polyneuropathy symptoms such as tingling, numbness, burning sensations, or weakness in the limbs. Sensory disturbances and, in some cases, motor deficits depending on nerve involvement. Possible facial weakness or paralysis if cranial nerves are affected. Additional symptoms may include headache and malaise.

Diagnosis Path: Diagnosis often involves a combination of clinical evaluation and laboratory testing. Blood tests to detect CMV antibodies or the presence of the virus’s DNA through PCR can confirm infection. Nerve conduction studies and electromyography may be performed to assess nerve damage. Imaging studies are generally not primary but may be used to rule out other causes of neurological symptoms. A detailed medical history and physical examination are essential to understanding the extent of neural involvement and systemic illness.

Treatment Protocols: Management of cytomegaloviral mononucleosis with polyneuropathy focuses on antiviral medications like ganciclovir, valganciclovir, or foscarnet, especially in cases involving significant symptoms or immunosuppressed individuals. Supportive care includes rest, pain management, and physical therapy to address nerve damage and maintain muscle strength. Treating underlying immune suppression and monitoring for potential complications are key components of care. In some cases, corticosteroids may be used to reduce nerve inflammation, but their use depends on individual circumstances and medical judgment.