Primary Cytomegalovirus Infection Causing Guillain-Barré Syndrome in a Living Renal Allograft Recipient

Concurrent acute myositis and Guillain-Barre syndrome in Cytomegalovirus infection - a rare case report

Background

Cytomegalovirus (CMV) is a double stranded DNA virus and ubiquitous in nature. Association of Guillain-Barre syndrome (GBS) and CMV is well known but CMV acute myositis is a rare condition. Restriction of movements of limbs due to severe pain in myositis may obscure the diagnosis of GBS and this may easily miss.

Case presentation

Here we describe a 29-year-old male presenting with pain and swelling of bilateral lower limbs which progressed rapidly with increasing serum creatine kinase levels with positive IgM CMV antibodies. In view of no improvement in clinical condition, patient was further evaluated and found to have concurrent GBS. He was treated with plasmapheresis and improved.

Conclusion

Cytomegalovirus infection presenting as acute myositis is a uncommon and further association with GBS is a rare occurrence.

Influenza Vaccination and Guillain-Barré Syndrome: Reality or Fear

Guillain-Barré syndrome (GBS) is an inflammatory disorder and an acute immune-mediated demyelinating neuropathy that causes reduced signal transmissions, progressive muscle weakness, and paralysis. The etiology of the syndrome still remains controversial and uncertain. GBS can be initiated and triggered by respiratory tract infections such as influenza, and intestinal infections such as Campylobacter jejuni. In addition, there is considerable evidence suggesting links between influenza vaccination and GBS. As reported previously, the incidence of GBS in individuals receiving swine flu vaccine was about one to two cases per million. Despite the influenza vaccine efficacy, its association with an immune-mediated demyelinating process can be challenging as millions of people get vaccinated every year. In this review we will discuss the association between influenza infection and vaccination with GBS by focusing on the possible immunopathological mechanisms.

Neurologic complications of kidney transplantation

Renal transplant is the most common organ transplant in the United States, and the frequency of kidney transplants continues to rise as transplant offers improved survival and quality of life compared to dialysis. However, complications are not uncommon and patients frequently encounter issues requiring hospitalization, especially in the first year postoperatively. Complications that arise are typically related to surgical complications, immunosuppressive medications, or infection due to immunosuppression. Neurological complications are fairly common post-operatively, and are associated with increased morbidity and mortality in this population. This review discusses the most common etiologies of neurological complications after kidney transplant, including infection, malignancy, medication related, acute neuropathy, and other neurological pathology.