Cytomegalovirus disease with Guillain–Barré syndrome in a cadaver renal allograft recipient: cause or coincidence

Abstract

Anecdotal reports of acute inflammatory demyelinating polyneuropathy (Guillain-Barré syndrome) with cytomegalovirus (CMV) suggested as the etiological agent have been described in transplant recipients with poor prognosis. We describe a 48-year-old man, a cadaveric renal allograft recipient on cyclosporine, mycophenolate mofetil and prednisolone, who developed febrile illness with unexplained anemia followed by progressive weakness of the upper and lower limbs. He was diagnosed as a case of Guillain-Barré syndrome (GBS). His CMV serology was positive by polymerase chain reaction (PCR). We treated him with both gancyclovir and intravenous immunoglobulins within a week of the onset of GBS and observed rapid recovery. Thus, search for CMV is warranted in transplant patients presenting with GBS, as early initiation of treatment with gancyclovir and immunoglobulins can help expedite recovery.