[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-419105-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-419105-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","cytomegalovirus-associated-central-pontine-myelinolysis-in-a-severely-immunocompromised-hivaids-patient","Cytomegalovirus-Associated Central Pontine Myelinolysis in a Severely Immunocompromised HIV/AIDS Patient","","Central pontine myelinolysis (CPM) is classically linked to rapid hyponatremia correction, but evidence suggests additional contributors in immunocompromised patients. This case report describes a 35-year-old man with untreated HIV/AIDS and stage IV Hodgkin lymphoma on chemotherapy who presented with acute hypoxic respiratory failure. Despite stable serum sodium, normal osmolarity and electrolytes, MRI showed a trident-shaped central pontine lesion consistent with CPM. Markedly elevated CMV viral load supported CMV-associated CPM; antiviral therapy produced partial neurologic improvement, though the patient left against medical advice.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/cytomegalovirus-associated-central-pontine-myelinolysis-in-a-severely-immunocompromised-hivaids-patient/419105/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/cytomegalovirus-associated-central-pontine-myelinolysis-in-a-severely-immunocompromised-hivaids-patient/419105.png","ImageObject",300,407,{"name":42,"@type":43},"Aditya","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-03","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",15,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What condition is described in this case report, and what is its usual cause?","Question",{"text":63,"@type":64},"The report describes central pontine myelinolysis (CPM). CPM is most commonly associated with rapid correction of hyponatremia, though other factors may contribute in immunocompromised patients.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How did clinicians determine that CMV was likely involved despite normal sodium trends?",{"text":68,"@type":64},"MRI showed a classic CPM lesion, while serum sodium fluctuations and other electrolytes remained normal. A markedly elevated cytomegalovirus (CMV) viral load, with inconclusive cerebrospinal fluid findings, supported CMV-associated CPM.",{"name":70,"@type":61,"acceptedAnswer":71},"What was the outcome after antiviral treatment?",{"text":72,"@type":64},"Antiviral therapy led to partial neurological improvement. 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This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98376  \nOpen Access Case Report  \nCytomegalovirus-Associated Central Pontine Myelinolysis in a Severely Immunocompromised HIV/AIDS Patient  \nHarvey B. De Nieva 1 , Wongelawit Zerihun 1 , Egesh Aryal 2, Dhiraj Nalabothu 3, Laxman Wagle 1  \n1. Internal Medicine, Ascension Saint Agnes Hospital, Baltimore, USA 2. Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, NPL 3. Internal Medicine, Trinity Medical Sciences University, Kingstown, VCT  \nCorresponding author: Harvey B. De Nieva, [harvey.de.nieva@ascension.org](harvey.de.nieva@ascension.org)  \nAbstract  \nCentral pontine myelinolysis (CPM) is most commonly associated with rapid correction of hyponatremia, yet emerging evidence indicates that additional factors, particularly in immunocompromised individuals, may also play a role. We report a case of a 35-year-old male with untreated HIV/AIDS and stage IV Hodgkin lymphoma undergoing chemotherapy, who presented with acute hypoxic respiratory failure. Despite no fluctuations in serum sodium and normal serum osmolarity and electrolytes, MRI revealed a classic tridentshaped lesion in the central pons consistent with CPM. Extensive workup showed a markedly elevated cytomegalovirus (CMV) viral load, while cerebrospinal fluid findings were inconclusive. In the context of profound immunosuppression and absence of other identifiable causes, CMV-associated CPM was strongly suspected. Initiation of antiviral therapy led to partial neurological improvement, but the patient ultimately left the hospital against medical advice. This report underscores the importance of considering opportunistic infections such as CMV as potential contributors to CPM in patients with advanced HIV, even in the absence of classic metabolic triggers. Broader awareness of these atypical etiologies may facilitate earlier recognition and more targeted management in this vulnerable population.  \nCategories: Neurology, Internal Medicine, Infectious Disease  \nKeywords: aids, cpm, hiv, ods, radiology  \nIntroduction  \nCentral pontine myelinolysis (CPM), a subset of osmotic demyelination syndrome (ODS), is a rare demyelinating disorder of the pons [1] . Initially associated with chronic alcoholism and malnutrition, the understanding of CPM pathogenesis expanded in the early 1980s with the recognition that rapid correction of hyponatremia is a key precipitating factor [2] . The clinical spectrum of CPM varies significantly, ranging from asymptomatic cases to severe manifestations such as locked-in syndrome, coma, or death [3] . While CPM is most commonly associated with sodium disturbances, reports implicating infections as a causative factor remain exceedingly rare. In adults, only a handful of cases have linked CPM to HIV/AIDS in the presence of minimal hyponatremia. For example, one case involved an AIDS patient with slowly corrected mild hyponatremia and hypoalbuminemia, who developed CPM, prompting hypotheses that immune dysregulation, low albumin, or opportunistic disease burden may increase vulnerability to osmotic stress [4] . In this report, we present a rare case of putative CMV-associated CPM in an adult patient with untreated HIV/AIDS.  \nCase Presentation  \nThe patient was a 35-year-old male with a significant past medical history of an untreated HIV/AIDS and a recently diagnosed stage IV classic Hodgkin lymphoma. His HIV had progressed to an advanced stage, with a CD4 count of nil, reflecting profound immunosuppression due to noncompliance with antiretroviral therapy. His wife reported that he had been compliant with bictegravir-emtricitabine-tenofovir alafenamide s","cbCaivsnqX7qH3Lz","https://ap.wps.com/l/cbCaivsnqX7qH3Lz","pdf",3939974,"English","# Abstract\n# Introduction\n# Case Presentation\n## Emergency presentation\n## Laboratory evaluation","[{\"question\":\"What condition is described in this case report, and what is its usual cause?\",\"answer\":\"The report describes central pontine myelinolysis (CPM). CPM is most commonly associated with rapid correction of hyponatremia, though other factors may contribute in immunocompromised patients.\"},{\"question\":\"How did clinicians determine that CMV was likely involved despite normal sodium trends?\",\"answer\":\"MRI showed a classic CPM lesion, while serum sodium fluctuations and other electrolytes remained normal. A markedly elevated cytomegalovirus (CMV) viral load, with inconclusive cerebrospinal fluid findings, supported CMV-associated CPM.\"},{\"question\":\"What was the outcome after antiviral treatment?\",\"answer\":\"Antiviral therapy led to partial neurological improvement. The patient ultimately left the hospital against medical advice.\"}]","Cytomegalovirus-Associated Central Pontine Myelinolysis in a Severely Immunocompromised HIV/AIDS Patient | PDF",1790615639,25]