Cytomegalovirus and varicella zoster virus coinfection-associated central hypoventilation syndrome (Ondine's Curse)

Abstract

Central hypoventilation syndrome (CHS) is a rare condition resulting from damage to the respiratory centers in the central nervous system (CNS). It can be congenital or acquired and can cause hypoventilation, inadequate gas exchange, and respiratory failure, often during sleep but sometimes even while awake. CHS can lead to respiratory failure and life-threatening complications if not identified promptly. In this report, we present a rare case of a patient with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), who developed CHS likely due to an opportunistic infection by cytomegalovirus (CMV) and varicella zoster virus (VZV), manifesting as a lesion in the medullary respiratory nuclei. After treatment with ganciclovir, the patient showed clinical improvement, and his medullary lesion resolved.

Keywords: Brainstem; CMV; Central hypoventilation syndrome; Cytomegalovirus; Encephalitis; VZV; Varicella zoster virus.

Fig. 1

A. T1 with contrast sagittal cut demonstrating the non-enhancing medullary lesion. B. T2 axial cuts at the level of the medulla showed bilateral hyperintensities. C. T2 axial cut through the medulla after gancyclovir treatment shows improvement in the medullary lesions.