Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Cytomegalovirus myositis complicated with hemophagocytic lymphohistiocytosis, acute renal failure, and colitis

Kinya Matsuo, M.D.1)2), Hideaki Nishihara, M.D.1), Michiaki Koga, M.D.1), Masatoshi Omoto, M.D.1), Junichi Ogasawara, M.D.1), Motoharu Kawai, M.D.1) and Takashi Kanda, M.D.1)

1)Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine
2)Present address: Department of Neurology, Yamaguchi Prefectural Grand Medical Center

A 60-years-old previously healthy man presented with acute renal failure and hemophagocytic lymphohistiocytosis (HLH). Both conditions improved after immunotherapies, but severe limb weakness with elevation of serum CK developed. Needle EMG showed myogenic changes with spontaneous activities and muscle weakness thereafter improved without adding further immunotherapies, suggesting that our patient had viral myositis. After the stabilization of limb weakness, cecal perforation occurred due to cytomegalovirus (CMV) enteritis and temporal significant change of anti-CMV IgG antibody titer was confirmed using paired serum samples. Upregulation of MHC-class I molecule and numerous regenerative muscle fibers were observed in muscle biopsy, but no evidence of direct CMV infection in muscle fibers were seen. Although CMV infection may cause either myositis, acute renal failure, HLH or colitis in individual patient, this is the first case which had been complicated by all these conditions subsequent to CMV infection.
Full Text of this Article in Japanese PDF (888K)

(CLINICA NEUROL, 58: 423|429, 2018)
key words: viral myositis, cytomegalovirus, hemophagocytic lymphohistiocytosis, acute renal failure, intestinal perforation

(Received: 7-Nov-17)