Late primary cytomegalovirus infection presenting with acute inflammatory demyelinating polyneuropathy in a heart transplant recipient: a case report and review of the literature

Abstract

Cytomegalovirus (CMV) infection is well recognized as a cause of morbidity and mortality in heart transplant recipients. Primary CMV infection can occur early post transplant in at-risk recipients with donor-derived infection, or any time after transplantation in community-acquired infection. We describe a unique case of primary CMV infection occurring 14 years after cardiac transplantation. In addition to end-organ CMV disease, this patient developed a post-infectious neurologic phenomenon, acute inflammatory demyelinating polyneuropathy. This entity has rarely been reported in the solid organ transplant population.

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

“…( 8 ) 44/M NS NS 14 yrs Cyclosporine, mycophenolate mofetil, and steroids No Yes G4/G1 Hodowanec et al. ( 9 ) 40/M +/− ICM 7 months Cyclosporine No Yes G5/G1 Steger et al. ( 10 ) 50/M +/− NICM 2 yrs NS Yes Yes G5/G3 Present study 56/M −/− ICM 21 months Mycophenolate, mofetil, and tacrolimus Yes No G2/G1 The clinical characteristics of all 7 reported cases of GBS after CMV in patients with heart transplants are summarized.…”

“…Of the 6 prior cases, 4 were also treated with IVIG. All patients had at least partial recovery from their GBS ( 7 , 8 , 9 , 10 , 11 ).…”

Very-late-onset cytomegalovirus disease: a case-report and review of the literature

“…Another case report described a primary CMV infection occurring 14 years post heart transplant [ 11 ]. This D−/R− 44 year-old-patient under prednisone, cyclosporine and mycophenolate mofetil was hospitalized for gastro-intestinal CMV disease.…”

Auditory neuropathy: from etiology to management

“…Various infectious diseases, such as toxoplasmosis, meningitis, cytomegalovirus infection, mumps and measles encephalitis can trigger auditory neuropathy, a proportion of which may be because of viral infections causing demyelinating lesions involving the auditory nerve [16]. In addition, thiamine deficiency has been shown to be the cause of auditory neuropathy in children, which induces damage and loss of inner hair cells because of a reduction in the high-affinity thiamin transporter protein encoded by SLC19A2 .…”