Guillain-Barré Syndrome Following Primary Cytomegalovirus Infection in a Patient with Liver Transplantation: a Case Report
Jaime Toro1, Jairo Gaitan Alfonso1, Thomas Medina1, Saul Reyes1
1Fundación Santa Fe de Bogotá
Objective:

To report the case of a patient who underwent liver transplantation and developed Guillain-Barré syndrome (GBS) as a result of primary cytomegalovirus (CMV) infection.


Background:

GBS is the most common etiology of paralysis worldwide and it is an autoimmune-mediated neuropathy that is frequently caused by a preceding infection. Although the relationship between CMV and GBS is well known, only about 4% of cases are specifically attributable to this infection. Likewise, few cases of GBS have been reported in the context of liver transplant recipients, and in the majority of cases, it is not ascribable to the CMV infection.


Design/Methods:
Not applicable.
Results:

 A 66-year-old male patient with a 5-month medical history of liver transplantation secondary to hepatocellular carcinoma, is seen in the emergency room with a progressive ascending limb weakness and foot dysesthesias for the past eight days. Interestingly, three days before the onset of the symptoms, he presented a self-resolved gastrointestinal infection. Neurological examination revealed decreased strength and areflexia in all extremities, especially in the lower limbs. Nerve conduction studies and electromyography showed an acute inflammatory demyelinating polyneuropathy (AIDP) consistent with the diagnosis of GBS. Lumbar puncture ruled out any potential neuro infections and revealed the typical albuminocytologic dissociation. Additionally, a FilmArray panel was negative for other gastrointestinal pathogens. However, a significant CMV serum viral load indicated an active infection. Therapy with IV immunoglobulin and valganciclovir was started, with symptoms considerably improving after five days.


Conclusions:
GBS can be a rare complication after solid organ transplantation. Although post-transplant immunosuppression is known to increase the likelihood of contracting CMV opportunistic infections, GBS has not been frequently linked to this condition. Also, to our knowledge, this is one of few reports where it occurs after a primary CMV infection in the context of a liver transplant recipient, while other frequent etiologies were ruled out.
10.1212/WNL.0000000000203124