Bilateral abducens palsy in a case of cytomegalovirus-associated Guillain–Barré syndrome

Abstract

Ophthalmoparesis in cytomegalovirus (CMV)-associated Guillain-Barré syndrome (GBS) is rare. We treated a 37-year-old woman with CMV-GBS who presented with an acute onset of generalized weakness and numbness in the extremities, followed by facial diplegia, which led to mechanical ventilation. She had increased IgM and IgG-type antibodies against CMV in the serum and increased IgM-type serum anti-GM2 ganglioside antibody was also noted, whereas anti-GQ1b ganglioside antibody was not found. She then developed the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). After recovery of consciousness due to SIADH, she exhibited bilateral abducens palsy, together with the recurrence of limb weakness and facial diplegia. Her neurological signs gradually recovered after high-dose intravenous administrations of immunoglobulin. CMV infection should be listed in the differential diagnosis of GBS patients who present with ophthalmoparesis.