Guillain-Barré Syndrome After Primary Cytomegalovirus Infection in a Patient With a Heart Transplant

Ting, Peter; Camaj, Anton; Bienstock, Solomon; Mitter, Sumeet S.; Barghash, Maya; Mancini, Donna

doi:10.1016/j.jaccas.2020.12.037

Cited by 4 publications

(1 citation statement)

References 11 publications

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“…Serious CNS damage and sensorineural hearing loss can be developed via transmitting HCMV from the placenta to the immature fetus. Other neurological complications associated with HCMV infection were reported, including seizures, microcephaly, spasticity, hypotonia, Guillain–Barré syndrome, and encephalitis [ 110 , 111 , 112 , 113 ].…”

Section: Flavonoids Target Human Herpesviruses Of the Nervous Systemmentioning

confidence: 99%

Flavonoids Target Human Herpesviruses That Infect the Nervous System: Mechanisms of Action and Therapeutic Insights

Šudomová¹,

Berchová‐Bímová

Mazuráková

et al. 2022

Viruses

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Human herpesviruses (HHVs) are large DNA viruses with highly infectious characteristics. HHVs can induce lytic and latent infections in their host, and most of these viruses are neurotropic, with the capacity to generate severe and chronic neurological diseases of the peripheral nervous system (PNS) and central nervous system (CNS). Treatment of HHV infections based on strategies that include natural products-derived drugs is one of the most rapidly developing fields of modern medicine. Therefore, in this paper, we lend insights into the recent advances that have been achieved during the past five years in utilizing flavonoids as promising natural drugs for the treatment of HHVs infections of the nervous system such as alpha-herpesviruses (herpes simplex virus type 1, type 2, and varicella-zoster virus), beta-herpesviruses (human cytomegalovirus), and gamma-herpesviruses (Epstein–Barr virus and Kaposi sarcoma-associated herpesvirus). The neurological complications associated with infections induced by the reviewed herpesviruses are emphasized. Additionally, this work covers all possible mechanisms and pathways by which flavonoids induce promising therapeutic actions against the above-mentioned herpesviruses.

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Section: Flavonoids Target Human Herpesviruses Of the Nervous Systemmentioning

confidence: 99%

Flavonoids Target Human Herpesviruses That Infect the Nervous System: Mechanisms of Action and Therapeutic Insights

Šudomová¹,

Berchová‐Bímová

Mazuráková

et al. 2022

Viruses

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Mycophenolate mofetil/tacrolimus

2021

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Mycophenolate mofetil/tacrolimus Cytomegalovirus infection and lack of efficacy: case reportA 56-year-old man developed cytomegalovirus infection during maintenance immunosuppressive therapy with tacrolimus and mycophenolate mofetil. Additionally, he experienced lack of efficacy during treatment with tacrolimus and mycophenolate mofetil.The man had a history of end-stage heart failure due to ischaemic cardiomyopathy for which he had undergone a left ventricular assist device implantation as a bridge to cardiac transplantation in April 2018. Both the donor and the recipient were seronegative for cytomegalovirus (CMV) prior to the transplant. He had a normal allograft function without allograft rejection. He was on tacrolimus and mycophenolate mofetil [dosages and routes not stated] for maintenance immunosuppression. In December 2019, he was hospitalised for CMV infection manifesting as fever and diarrhoea.The man received ganciclovir for 6 days and then transitioned to valganciclovir. By discharge, his fever and diarrhoea had resolved. On follow-up, the CMV DNA was undetectable. Three weeks after the discharge (i.e. in January 2020), he presented to the hospital with 10 days of ascending sensory loss and proximal muscle weakness. Physical examination was notable for sensory loss in the lower extremities to just below the knees, in the hands and forearms and on the anterior tongue. He had weakness of the deltoids, biceps and intrinsic muscles of the hand, as well as weakness with hip flexion and dorsiflexion of the feet. He had a neuropathic gait. The remainder of his examination, including the cardiopulmonary examination, was unremarkable. Laboratory investigations revealed a normal basic metabolic panel and complete blood count. His liver function tests were improving as compared to his prior admission. Thyroglobulin, thyroid peroxidase and thyroid stimulating antibodies were absent. Thiamine, vitamin B12, serum protein electrophoresis, immunofixation electrophoresis and copper levels were normal. Human immunodeficiency virus test, rapid plasma reagin, CMV PCR and Epstein-Barr virus PCR were negative. Tacrolimus level was 8.9 ng/mL. An underlying hyperthyroidism was also noted. His CRP was found to be elevated 14.4 mg/mL. An antinuclear antibodies titer was positive at 1:320 in a speckled pattern. Erythrocyte sedimentation rate was 40 mm/h. Antibodies to MAG, SGPG, Purkinje Cell/Neuronal Nuclear, Asialo-GM1, GD1A and GQ1B were negative. Antibodies to the ganglioside GD1b were elevated to 74IV. An MRI of the entire spine showed possible enhancement of the cauda equine nerve roots at the L5-S1 level. Nerve conduction studies were suggestive of subacute Guillain-Barre Syndrome. He was treated with immune-globulin and valganciclovir was discontinued. The hyperthyroidism was treated with methimazole. Shortly after the initiation of immune-globulin therapy, he developed shortness of breath. A right heart catheterisation showed borderline high filling pressures but a normal cardiac index. He was empirically treated for ...

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Guillain-Barré Syndrome Secondary to Cytomegalovirus Infection in a Pediatric Kidney Transplant Patient

Lopes,

Araujo,

Gallindo

et al. 2024

BJT

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The association between Guillain-Barré syndrome (GBS) and cytomegalovirus (CMV ) is already well established in the literature, "rst reported in 1967. However, this association is rare in solid organ transplant patients, although the incidence of symptomatic CMV infection is higher in this population. Due to its potential severity, high morbidity and mortality, the possibility of GBS cannot be ruled out in the case of neurological complications in transplant patients. In this report, a case of GBS secondary to CMV is described in an eight-year-old kidney transplant patient in the pediatric age group, an interval with an even greater scarcity of reports on this association. !e patient had negative antibodies (IgG and IgM) for CMV in pre-transplant tests, while the donor had positive IgG antibodies, meaning a higher risk of developing the disease. !e clinical condition began approximately two months after the transplant, with classic symptoms and the evolution of GBS. !e clinical aspects, diagnosis, treatment and evolution of the disease are discussed, in addition to the evidence in the world literature.

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Guillain-Barré Syndrome After Primary Cytomegalovirus Infection in a Patient With a Heart Transplant

Cited by 4 publications

References 11 publications

Flavonoids Target Human Herpesviruses That Infect the Nervous System: Mechanisms of Action and Therapeutic Insights

Flavonoids Target Human Herpesviruses That Infect the Nervous System: Mechanisms of Action and Therapeutic Insights

Mycophenolate mofetil/tacrolimus

Guillain-Barré Syndrome Secondary to Cytomegalovirus Infection in a Pediatric Kidney Transplant Patient

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