Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Successful corticosteroid therapies in a case of acute motor, sensory, autonomic neuropathy after cytomegalovirus infection

Yuto Uchida, M.D.1), Haruki Koike, M.D., Ph.D.2), Takuya Oguri, M.D., Ph.D.1), Hideki Kato, M.D., Ph.D.1), Hiroyuki Yuasa, M.D., Ph.D.1) and Shigehisa Mitake, M.D., Ph.D.1)

1)Department of Neurology, Tosei General Hospital
2)Department of Neurology, Nagoya University Graduate School of Medicine

We report a rare case of autonomic neuropathy associated with cytomegalovirus (CMV) infection. The patient, a 53-year-old male, was admitted to our hospital because of prolonged fever, headache and neck stiffness followed by urinary retention. Cerebrospinal fluid examination revealed pleocytosis (219/mm3, predominantly lymphocytes) with a markedly increased protein level (217 mg/dl) and serum IgM anti-CMV antibody was detected. While his meningitic symptoms gradually improved after intravenous administration of ganciclovir, he complained of numbness in the extremities and difficulty in walking. Neurologically, marked orthostatic hypotension, glove and stocking type of paresthesia, severe muscle weakness in extremities, and neurogenic atonic bladder were noted. Nerve conduction studies showed normal except for F-waves, which were absent in the left tibial nerve. A sural nerve specimen appeared normal in both myelinated and unmyelinated fibers. He was given immunological therapies such as corticosteroid and intravenous high dose immunoglobulin therapies. After corticosteroid therapies, not only sensory and motor symptoms but also autonomic symptoms remarkably improved. Of the anti-ganglioside antibodies, IgM anti-GM1 antibody and IgM anti-GM2 antibody were detected. Although some cases with Guillain-Barré syndrome preceded by CMV infection have been reported, few cases with autonomic neuropathy have been described in association with successful corticosteroid therapies.
Full Text of this Article in Japanese PDF (524K)

(CLINICA NEUROL, 55: 339|344, 2015)
key words: cytomegalovirus, autonomic neuropathy, anti-ganglioside antibodies, Guillain-Barré syndrome

(Received: 18-Jun-14)