Concurrent acute myositis and Guillain-Barre syndrome in Cytomegalovirus infection – a rare case report

Abstract

Background Cytomegalovirus (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 presentation Here 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. Conclusion Cytomegalovirus infection presenting as acute myositis is a uncommon and further association with GBS is a rare occurrence.

COVID-19 Vaccination a Cause of Guillain-Barré Syndrome? A Case Series

“…GBS is a heterogeneous disorder characterized by rapidly progressive, symmetrical ascending paralysis with areflexia or hyporeflexia triggered by certain infections, such as C. jejuni, cytomegalovirus, M. pneumoniae, Epstein-Barr virus, and Zika virus [4][5][6][7]. Studies done in the past during the 1976 swine flu outbreak revealed that GBS developed after vaccination, with 8.8 cases per million recipients of influenza vaccine being documented [16].…”

“…GBS is usually preceded by an infectious trigger by bacterial or viral agents most commonly associated with infection caused by Campylobacter jejuni (C. jejuni) [4]. In addition, recent infections by the Zika virus, Epstein-Barr virus (EBV), and Cytomegalovirus (CMV) have also been reported as antecedent causes of GBS [5][6][7]. Severe acute respiratory syndrome (SARS-CoV-2) infection, resulting in the coronavirus disease 2019 (COVID-19) pandemic, is associated with Guillain-Barré syndrome (GBS) [8][9][10].…”

Guillain-Barré syndrome (GBS) complicated by rhabdomyolysis (RML): Case reports of 2 children and literature review

“…Review of the medical literature identified 5 patient case reports of GBS that were complicated with RML ( Table 2 ) ( 5 – 9 ). Therefore, a total of 7 GBS patients experienced concomitant RML.…”

“…Some patients initially experience muscle pain or nerve root pain ( 2 ). During the course of GBS, 16–27% of patients show an elevation of serum creatine kinase (CK) levels ( 3 , 4 ) but only rarely is GBS complicated with rhabdomyolysis (RML) ( 5 – 9 ). The research history of GBS in Beijing Children's Hospital (BCH), which is affiliated with Capital Medical University, can be traced back to the 1990s.…”

About a rare association: Guillain–Barré Syndrome and polymyositis

“…The simultaneous occurrence of GBS and acute myositis has been rarely reported in the literature in the context of acute viral myositis caused by Mycoplasma pneumoniae, Cytomegalovirus, and dengue virus. 13 , 14 , 15 …”