Parenteral ganciclovir treatment of a CMV associated Guillain-Barre syndrome in an immunocompetent patient

We present a case report of a 30-year-old immunocompetent woman showing an acute mononucleosis-like syndrome with severe malaise, headache, arthralgia s and myalgias. Biochemical and haematological parameters revealed a slight elevation of the liver transaminases and a relative lymphocytosis with aty pical lymphocytes. During the following two days, the patient developed a G uillain-Barre syndrome with rapidly progressing tetraparesis and double-sid ed facial palsies; cardiac arrhythmia lead to transmission to an intensive- care unit. The patient received intravenous immunoglobulin therapy for five days without an improvement of the general or neurological state. The proo f of high-titer IgG and IgM antibodies against cytomegalovirus (CMV) establ ished the diagnosis of CMV-mononucleosis. Treatment with intravenous gancic lovir led to a rapid improvement of malaise, myalgias and arthralgias and a normalisation of the liver and haematological parameters. Restitution of t he tetraparesis was supported by intensive physiotherapy.