Abstract

CYTOMEGALOVIRUS DISEASE CAUSING GUILLAINBARRE’ SYNDROME IN LIVING RENAL ALLOGRAFT RECIPIENT: A RARE PRESENTATION Deepti D Torri ; Madhu Bhaskaran; Ernesto Molmenti; Mala Sachdeva NSLIJHS-Hofstra NS-LIJ School of Medicine, Great Neck, NY, USA. Guillain–Barre syndrome (GBS) is a rare neurological complication described in renal allograft recipients. To our knowledge; there is only one case report of a patient three months post cadaveric renal transplant who presented with simultaneous Cytomegalovirus (CMV) infection and GBS. We report the first case of GBS presenting after acute CMV infection in a patient who had received a living donor renal transplant. This is 47 year-old man with medical history significant for hypertension, metastatic melanoma of lung in remission and end stage renal disease. He underwent living unrelated renal transplant in 2008. His donor was CMV positive, and he was CMV negative. He was prophylaxed with valganciclovir for CMV for one and a half year. Two years post transplant he first presented with fever, chills, myalgias, and headache for seven days. His workup revealed mild thrombocytopenia, increase in liver transaminases, and a stable creatinine. Diagnosis of acute CMV infection was made based on positive CMV IgM, negative, CMV IgG and CMVPCR with 4800 copies/ml. Lumbar puncture (LP) and other serologic workup were negative. Patient was started on oral valganciclovir. Five days after initial presentation, he developed numbness and tingling in his hands and feet which ascended to his elbows and knees with decreased temperature sensation in his extremities. Two days later, his neurologic exam had changed significantly and involved tetraparesis with absent deep tendon reflexes bilaterally. Based on these findings, a diagnosis for GBS was made. He again underwent an LP, CSF fluid was typical for albuminocytologic dissociation. The patient was promptly started on plasmapheresis and was continued on oral valganciclovir. He received a total of 12 cycles of plasmapheresis and had complete recovery in 14 days. Post-transplant GBS in association with CMV has rarely been described. Early recognition and prompt treatment is critical to both proper management and overall outcomes. Plasmapheresis along with oral valganciclovir had significant impact on our patient’s clinical course, resulting in full recovery.

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