GUILLAIN-BARRE-SYNDROME ASSOCIATED WITH C YTOMEGALOVIRUS-INFECTION AFTER RENAL-TRANSPLANTATION

The Guillain-Barre syndrome associated with cytomegalovirus infection is a recognized entity of unknown pathogenesis. We observed two charac teristic cases with acute polyradiculoneuropathy which occurred after renal transplantation. Both patients fulfilled the diagnostic criteria for Guillain-Barre syndrome: tetraparesis with diffuse areflexia and moderate sensorial signs, high protein level in cerebrospinal fluid wi thout cellular reaction, slow or blocked nerve conduction and partial cure after several months delay. In two-thirds of such cases, the synd rome follows an episode of infection. Cytomegalovirus has been recogni zed as a possible association. The demyelinating polyradiculoneuropath y induced by cytomegalovirus has been reported essentially in immunode pressed patients infected with the human immunodeficiency virus in who m a pathogenic role for cytomegalovirus in peripheral nerves has been suggested. In our two cases, the cytomegalovirus infection occurred be fore onset of the acute polyradiculoneuropathy. In both cases, specifi c IgM antibodies and clear IgG positivization occurred before the firs t signs of neurological impairment even though neither the virus nor s pecific antibodies could be concomitantly detected in the cerebrospina l fluid. Despite the frequency of cytomegalovirus infections in transp lant recipients, to our knowledge, only 9 cases of Guillain-Barre synd rome after transplantation have been reported and the exact mechanism remains to be ascertained. These two cases suggest that the onset of t he Guillain-Barre syndrome after renal transplantation was closely rel ated to cytomegalovirus infection. Adequate measures should be taken t o quickly diagnose such cases in order to instore rapid treatment for the polyradiculoneuropathy. In addition, this particular situation of post-transplantation onset might help better understand the exact role of cytomegalovirus infection in the Guillain-Barre syndrome.