Neuromyositis Associated with Cytomegalovirus Infection in an Immunocompetent Patient with Antineutrophil Cytoplasmic Antibodies-Associated Vasculitis

Abstract The role of CMV in ANCA-positive vasculitis is controversial. A 40-year-old man, with an unremarkable medical history, presented with progressive muscle weakness of all four limbs, accompanied by diffuse myalgia, arthralgia, and a 10 kg weight loss 2 months before admission to the Neurology Department of our hospital. Clinical examination revealed a flaccid tetraparesis with absent reflexes on the lower limbs and marked muscle atrophy. Electrophysiological investigations were consistent with a demyelinating motor polyradiculoneuropathy. Laboratory data showed AST=1137 IU/L (normal<37 IU/L), ALT=582 IU/L (normal<41 IU/L), C-reactive protein (CRP)=19 mg/L (normal<8 mg/L), CPK=13779 IU/L (normal<397). and LDH=911 IU/L (normal<192). CMV ELISA (serum) was strongly positive and CMV DNA by polymerase chain reaction (PCR) in blood and CSF also was positive. Immunologic screening revealed positive anti-myeloperoxidase antibodies anti-MPO=56,9 IU/mL (normal <9 IU/mL; ELISA). The inflammatory process involv...