Background: Guillain-Barré syndrome(GBS) is the prototype of postinfectious autoimmune diseases. We observed a cluster of 4 male cases admitted to neurology ward and intensive care unit of a medical center in February 2017. Objective: To study probable etiologies of GBS cluster. Patients and Methods/Material and Methods: Informed consents were obtained frompatients under a researchproject (IRB 200906026R). We evaluated clinical histories and laboratory data for determining potential causes. The serial comparison ofvirus titers was performed for cytomegaloviru (CMV) and herpes simplex virus (HSV) infection. Polymerase chain reaction (PCR) studies were conducted for virus identification. Results: All 4 patients had only mild cold-like symptoms without fever about 2 weeks before onset. The temporal changes of modified neurological disability scores were shown along treatment courses. Recent CMV infection was documented in two young cases with acute motor sensory axonal neuropathy (AMSAN). The 22-year-old homosexual patient with severe AMSAN associated with CMV infection had initial sensory deficits, rapidly developing quadriplegia and respiratory failure, related to anti-GM2 IgM antibody. We excluded the possibility of HIV infection in these two young men. A 72-year-old man had history of probably asbestos exposure, and cancer-related immune dysregulation was suspected. PCR studies excluded possibility of Campylobacter jejuni in all cases. The studies for enterovirus will be presented. The epidermal nerve densities will be presented for two cases. Conclusion: Our cluster investigation shows that CMV infection is the major viral infection associatedwith young AMSAN in our hospital, and sexual history should be inquired for differential diagnosis.
Date:
2017-10
Relation:
Journal of the Neurological Sciences. 2017 Oct;381(Suppl. S):650.
