CMV-ASSOCIATED ACUTE GUILLAIN-BARRE-SYNDR OME AFTER LIVER-TRANSPLANTATION

We report the case of a 52-year old cytomegalovirus-(CMV)-negative pat ient, who underwent liver transplantation (CMV-positive donor). Follow ing a flu-like illness 6 weeks after transplantation he developed tetr aplegia with breathing difficulties within 24 hours. A diagnosis of ac ute Guillain-Barre syndrome (CBS) was made. Routine tests for CMV anti gen were negative on day 6 and 7 of the disease. On day 8 CMV antigen test became positive and elevated IgM and IgG-titres against CMV were detected one day later. After 20 days of ganciclovir CMV antigen was n o longer detectable; however, the neurological symptomatology remained unchanged. Thirteen months later he was able to walk again with a sti ck. The close monitoring for CMV infection prior to the evolving GES i llustrates the dynamics of this parainfectious process. Acute and chro nic immune reactions to the graft are discussed as further inductors o f the CBS. Besides, our case shows specific problems of GBS therapy pa rticularly in liver transplantation.