Inflammatory demyelinating polyneuropathy in a kidney transplant patient with cytomegalovirus infection.

Abstract

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare disease with a prevalence of approximately 1/100 000 in the general population [1]. The pathogenesis of the demyelination is thought to be immune mediated but the mechanism is uncertain [2]. Antecedent infections are reported in 35% of the patients with CIDP, especially cytomegalovirus (CMV) infections [3]. The CMV infection probably triggers an immune reaction against components of peripheral nerve myelin, for instance myelin associated glycoprotein/sulphated glucuronyl paragloboside [4]. Although CMV infections occur frequently after kidney transplantation, demyelinating polyneuropathy is very rare in organ transplant recipients. In contrast CIDP is relatively frequent in patients with the acquired immunodeficiency syndrome (AIDS) and a relationship with CMV infection is suspected [5–7]. This is the first case report of a patient after renal transplantation with chronic inflammatory demyelinating polyneuropathy reflecting recurrence of viraemia, suggesting that active replication of CMV may be accompanied by flare-ups of the CIDP. We speculate about the pathogenesis of CIDP in this patient.