Abstract
BackgroundCytomegalovirus (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 presentationHere 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.ConclusionCytomegalovirus infection presenting as acute myositis is a uncommon and further association with GBS is a rare occurrence.
Highlights
Cytomegalovirus (CMV) is a double stranded DNA virus and ubiquitous in nature
Cytomegalovirus is a double stranded DNA virus belonging to the Herpesviridae family (HHV-5)
Acute viral myositis is an uncommon manifestation of CMV and direct infection of muscles and autoimmunity are likely pathogenesis
Summary
Cytomegalovirus (CMV) associated neurological manifestations range from encephalitis, meningitis, myelitis to polyradiculopathy and rarely multifocal neuropathy [1]. Occurrence of concurrent GBS and acute myositis have rarely been reported in the literature with dengue fever and mycoplasma pneumoniae infection [3, 6] but not with CMV infection. After 3 days of asymptomatic period, he started having acute onset severe dull aching diffuse pain in both lower limbs with swelling and difficulty in walking. He reported oral ulceration and difficulty in swallowing. Superficial reflexes were absent including plantar response His investigations revealed normal complete blood count (Hb – 17.8 g/dL, Total Leucocytes count – 6600/μL, platelet count – 357,000/ μL), and deranged liver function (ALT- 220 IU/L and AST = 549 IU/L).
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